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Role of fibrin D-dimer testing in emergency medicine
  1. A Wakai1,
  2. A Gleeson1,
  3. D Winter2
  1. 1Department of Emergency Medicine, Beaumont Hospital, Dublin, Republic of Ireland
  2. 2Department of Surgery, Beaumont Hospital
  1. Correspondence to:
 Dr A Wakai, Department of Emergency Medicine, Beaumont Hospital, Dublin 9, Ireland; 


Objectives: Systemic values of the fibrinolytic plasma marker fibrin D-dimer are raised in a variety of acute clinical conditions. D-dimer values can now be rapidly determined and used to aid diagnosis in emergency medicine. However, despite clinical guidelines, inappropriate and unnecessary measurement of D-dimer values is a significant clinical problem. An understanding of the pathophysiological basis and limitations of the value of D-dimer values may help reduce this problem. This review discusses the pathophysiology of the fibrinolytic system. The currently used assays, clinical indications, and limitations of D-dimer measurement are reviewed. Finally, the potential future clinical indications for measurement of D-dimer values in emergency medicine are discussed.

Methods: Literature on D-dimer was identified from Medline, along with cross referencing from the reference lists of major articles on the subject

Results and conclusions: Systemic D-dimer values aids diagnosis, and is potentially a prognostic indicator, in a variety of clinical conditions in emergency medicine. However, it has limited specificity in patients with comorbid conditions. Although, currently, there is no standard D-dimer assay, immunoturbidimetric assays are the most suitable for use in emergency medicine

  • D-dimer
  • DD, D-dimer
  • VTE, venous thromboembolism
  • tPA, tissue plasminogen activator
  • XL-Fg, crosslinked fibrin
  • FDP, fibrin degradation product
  • ELISA, enzyme linked immunosorbent assay
  • HMW, high molecular weight
  • LMW, low molecular weight
  • FACT, Fibrin Assay Comparison Trial
  • CT, computed tomography
  • PE, pulmonary embolism
  • DVT, deep vein thrombosis
  • PTP, pretest probability
  • CHD, coronary heart disease
  • ACS, acute coronary syndrome
  • MI, myocardial infarction

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