Can very high level of D-dimer exclusively predict the presence of thromboembolic diseases?

Background: D-dimer quantitative test is mainly used to rule out the presence of thromboembolic diseases (TEDs). Whether very high D-dimer (100 times above the cutoff point) can exclusively indicate the presence of TED should be known.

Methods: D-dimer was detected by a quantitative immunoturbidimetric assay. The normal value is 0.2-0.7 mg/L fibrinogen equivalent units (FEUs). During the year of 2009, 1,053 D-dimer tests were performed. We analyzed the results of these patients to find out the causes of very high D-dimer.

Results: The mean value of D-dimer in the 1,053 tests was 8.56 mg/L FEU, ranging from <0.2 mg/L to 563.2 mg/L FEU. Of them, 28 samples from 21 patients had very high D-dimer value: >50 mg/L FEU. Of the 21 patients, 9 (43%) had TED, 1 had suspected TED, but not proved by computed tomographic (CT) angiogram, 3 had massive gastrointestinal or other site bleeding, 3 patients had cardiac arrest with samples taken immediately after recovery from cardiopulmonary resuscitation (CPR), 2 had sepsis with disseminated intravascular coagulation (DIC), 1 had postpartum hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome with acute pulmonary edema and renal failure, 1 had multiple traumatic injury, and 1 received thrombolytic therapy.

Conclusion: Although TED was the most frequently seen disorder in patients with very high D-dimer value, very high D-dimer was not necessary exclusively the marker of TED. Other disorders such as massive bleeding, status post CPR, sepsis with DIC, multiple traumatic injuries, hyperfibrinolysis and HELLP syndrome can also have very high D-dimer.