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The Jury Is Still Out on Routine Use of D-Dimer in Medical Illness

      To the Editor:
      We read with interest the prospective observational study by Nickel et al wherein they looked at the diagnoses and outcomes of emergency patients with an elevated D-dimer.
      • Nickel C
      • Kellett J
      • Cooksley T
      • Lyngholm L
      • Chang S
      • Imfeld S
      • et al.
      The Diagnoses and Outcomes of Emergency Patients With an Elevated D-Dimer Over the Next 90 Days.
      Although their conclusions were mostly valid, it was not within the scope of their study to make the recommendation to routinely measure D-dimer for every patient presenting with an acute medical illness.
      The researchers have made the finding that an elevated D-dimer in their sample was associated with higher risk of admission, re-presentation to hospital, and ultimately mortality. However, this alone is not evidence enough to propose routine usage of the test.
      Research has previously demonstrated that ordering a D-dimer is clinically useful in diagnosing venous thromboembolism.
      • Hendriksen J
      • Geersing G
      • van Voorthuizen S
      • Oudega R
      • ten Cate-Hoek A
      • Joore M
      • et al.
      The cost–effectiveness of point-of-care D-dimer tests compared with a laboratory test to rule out deep venous thrombosis in primary care.
      ,
      • Duriseti R
      • Brandeau M.
      Cost-Effectiveness of Strategies for Diagnosing Pulmonary Embolism Among Emergency Department Patients Presenting With Undifferentiated Symptoms.
      However, its clinical application in some other illnesses have not proved as fruitful.
      • Xiong L
      • Li S
      • Dai M.
      Comparison of D-dimer with CRP and ESR for diagnosis of periprosthetic joint infection.
      The study design is neither a comparative analysis, nor is it a cost-effective analysis. There is no evidence to date that the routine use of D-dimer in addition to current gold standard biomarkers for patients presenting with acute medical illnesses leads to favorable outcomes or reduced costs.

      References

        • Nickel C
        • Kellett J
        • Cooksley T
        • Lyngholm L
        • Chang S
        • Imfeld S
        • et al.
        The Diagnoses and Outcomes of Emergency Patients With an Elevated D-Dimer Over the Next 90 Days.
        The American Journal of Medicine. 2021; 134: 260-266.e2
        • Hendriksen J
        • Geersing G
        • van Voorthuizen S
        • Oudega R
        • ten Cate-Hoek A
        • Joore M
        • et al.
        The cost–effectiveness of point-of-care D-dimer tests compared with a laboratory test to rule out deep venous thrombosis in primary care.
        Expert Review of Molecular Diagnostics. 2014; 15: 125-136
        • Duriseti R
        • Brandeau M.
        Cost-Effectiveness of Strategies for Diagnosing Pulmonary Embolism Among Emergency Department Patients Presenting With Undifferentiated Symptoms.
        Annals of Emergency Medicine. 2010; 56: 321-332.e10
        • Xiong L
        • Li S
        • Dai M.
        Comparison of D-dimer with CRP and ESR for diagnosis of periprosthetic joint infection.
        Journal of Orthopaedic Surgery and Research. 2019; 14