HORIBA hemostasis

Hemostasis Guide

Fibrin Formation & Degradation


D-dimers, specific degradation products of fibrin, are markers for activation of plasma coagulation and/or fibrinolysis.

Venous Thromboembolism

An age-adjusted D-dimer cutoff combined with probability assessment can rule out the diagnosis of Pulmonary Embolism (PE) and Deep Vein Thrombosis (DVT) in emergency department patients with clinical suspicion.

The D-dimer result should be interpreted according to the age-adjusted cutoff

- In patients younger than 50 years, PE is excluded if D-dimer value < 500 μg/L.

- In patients 50 years or older, PE is excluded if D-dimer value < age multiplied by 10.

Disseminated Intravascular Coagulation - DIC

D-dimer concentrations are increased in patients with DIC. A normal level of D-dimer has excellent negative predictive value and generally excludes a diagnosis of DIC. Repeated and sequential measurements of D-dimer levels to capture the course of the disease may provide additional diagnostic information in patients when there is a strong clinical suspicion of DIC but the initial D-dimer value is normal.

COVID patients

D-dimer level is associated with the severity of COVID-19.

D-dimer can be used as a prognostic marker for Covid-19 disease mortality and severity in hospitalized patients.

D-dimer value ≥ 2.01 μg/mL can effectively predict in-hospital mortality in patients with COVID-19.

Some factors influence the sensitivity and specificity in D-dimer testing, such as the extent of thrombosis and fibrinolytic activity, duration of symptoms, age, surgical procedures, anticoagulants, and comorbid conditions such as inflammatory states, cancer, pregnancy and the postpartum period.


Righini M, Perrier A, De Moerloose P, Bounameaux H. D-dimer for venous thromboembolism diagnosis: 20 years later. J Thromb Haemost 2008;6:1059-71.

Righini M, Van Es J, Den Exter PL, et al. Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism: The ADJUST-PE Study. JAMA. 2014;311(11):1117–1124. doi:10.1001/jama.2014.2135

D-dimer to guide the duration of anticoagulation Therapy. G Palareti N Engl J Med 355:1780, October 26, 2006.

Pulivarthi, Swaroopa & Gurram, Murali. (2014). Effectiveness of D-Dimer as a Screening Test for Venous Thromboembolism: An Update. North American journal of medical sciences. 6. 491-499. 10.4103/1947-2714.143278.

Yu, H. H., Qin, C., Chen, M., Wang, W., & Tian, D. S. (2020). D-dimer level is associated with the severity of COVID-19. Thrombosis research, 195, 219–225. https://doi.org/10.1016/j.thromres.2020.07.047

Soni, Mamta et al. “D-dimer level is a useful predictor for mortality in patients with COVID-19: Analysis of 483 cases.” Diabetes & Metabolic Syndrome vol. 14,6 (2020): 2245–2249. doi:10.1016/j.dsx.2020.11.007

Wagner, J., Garcia-Rodriguez, V., Yu, A. et al. Elevated D-Dimer Is Associated with Multiple Clinical Outcomes in Hospitalized Covid-19 Patients: a Retrospective Cohort Study. SN Compr. Clin. Med. (2020).

Disseminated Intravascular Coagulation - DIC. ARUP Consult®. Retrieved November 30, 2020, arupconsult.com/content/disseminated-intravascular-coagulation

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