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Five steps for the use and interpretation of D-dimer in the Emergency Department

  • Elisa GesuEmail author
  • Anna Maria Rusconi
  • Elisa Ceriani
CE - Clinical Notes
  • 17 Downloads

Introduction

D-dimer is one of the major fibrin clot degradation products, released from cleavage of crosslinked fibrin by plasmin during fibrinolysis process. Since its introduction in 1990, D-dimer dosage has been proposed and used as a marker for several acute pathologies in which thrombosis or fibrinolysis processes are involved. Blood D-dimer’s values rise in several situations such as inflammation, neoplastic disease, autoimmune and rheumatic diseases, trauma, liver disease, pregnancy and age [1]. The purpose of this paper, part of a series of articles on biomarkers in the emergency medicine setting [2], is to provide a few practical steps that we think should be followed by the physician to correctly test and interpret D-dimer levels when evaluating patients.

Step 1: knowledge of the available assays

Several kinds of D-dimer assays are available.

First, they can differ for technical method of measure of the D-dimer concentration in blood. The most diffuse are ELISA and...

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

None.

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

References

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    The Task Force for the Diagnosis and Management of Acute Pulmonary Embolism of the European Society of Cardiology (ESC) (2014) 2014 ESC Guidelines on the diagnosis and management of acute pulmonary embolism. Eur Heart J 35:3033–3080CrossRefGoogle Scholar
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    Furlan L, Rusconi AM, Ceriani E (2017) Five steps for use and interpretation of troponin in the Emergency Department. Intern Emerg Med 12(7):1055–1058CrossRefGoogle Scholar
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    Ceriani E, Combescure C, Le Gal G et al (2010) Clinical prediction rules for pulmonary embolism: a systematic review and meta-analysis. J Thromb Haemost 8:957–970Google Scholar
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    Flores J, García de Tena J, Galipienzo J et al (2016) Clinical usefulness and safety of an age-adjusted D-dimer cutoff levels to exclude pulmonary embolism: a retrospective analysis. Intern Emerg Med 11(1):69–75CrossRefGoogle Scholar
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    Gorla R, Erbel R, Kahlert P et al (2017) Accuracy of a diagnostic strategy combining aortic dissection detection risk score and D-dimer levels in patients with suspected acute aortic syndrome. Eur Heart J Acute Cardiovasc Care 6(5):371–378CrossRefGoogle Scholar

Copyright information

© Società Italiana di Medicina Interna (SIMI) 2019

Authors and Affiliations

  1. 1.UOC Pronto Soccorso E Medicina D’Urgenza, Fondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoMilanItaly
  2. 2.S.C. Pronto Soccorso E Medicina D’UrgenzaOspedale Santa CoronaPietra LigureItaly
  3. 3.Dipartimento Di Medicina Interna E Specializzazioni MedicheFondazione IRCCS Ca’ Granda, Ospedale Maggiore PoliclinicoMilanItaly

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