D-dimer: An Overview of Hemostasis and Fibrinolysis, Assays, and Clinical Applications

Adv Clin Chem. 2015:69:1-46. doi: 10.1016/bs.acc.2014.12.001. Epub 2015 Feb 7.


D-dimer is the smallest fibrinolysis-specific degradation product found in the circulation. The origins, assays, and clinical use of D-dimer will be addressed. Hemostasis (platelet and vascular function, coagulation, fibrinolysis, hemostasis) is briefly reviewed. D-dimer assays are reviewed. The D-dimer is very sensitive to intravascular thrombus and may be markedly elevated in disseminated intravascular coagulation, acute aortic dissection, and pulmonary embolus. Because of its exquisite sensitivity, negative tests are useful in the exclusion venous thromboembolism. Elevations occur in normal pregnancy, rising two- to fourfold by delivery. D-dimer also rises with age, limiting its use in those >80 years old. There is a variable rise in D-dimer in active malignancy and indicates increased thrombosis risk in active disease. Elevated D-dimer following anticoagulation for a thrombotic event indicates increased risk of recurrent thrombosis. These and other issues are addressed.

Keywords: D-dimer; Deep venous thrombosis; Disseminated intravascular coagulation; Fibrinolysis; Pulmonary embolus.

Publication types

  • Review

MeSH terms

  • Age Factors
  • Aged, 80 and over
  • Biomarkers / blood*
  • Blood Specimen Collection
  • Disseminated Intravascular Coagulation / blood*
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis*
  • Fibrin Fibrinogen Degradation Products / physiology*
  • Fibrinolysin / metabolism
  • Fibrinolysis*
  • Hemostasis*
  • Humans
  • Plasminogen / metabolism
  • Pregnancy
  • Venous Thromboembolism / blood*


  • Biomarkers
  • Fibrin Fibrinogen Degradation Products
  • fibrin fragment D
  • Plasminogen
  • Fibrinolysin