D-Dimer Testing: Laboratory Aspects and Current Issues

Thachil, Jecko; Lippi, Giuseppe; Favaloro, Emmanuel J.

doi:10.1007/978-1-4939-7196-1_7

Cited by 65 publications

(96 citation statements)

References 56 publications

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“…The most important changes involve a substantial increase in the values of VWF:Ag and FVIII, which otherwise are considered highly associated prothrombotic risk factors. 28,29 Likewise, we found a concomitant enhancement of D-dimer values, which is a well-established biomarker of blood coagulation activation, 30 compounded by a significant reduction of APTT, which is also considered a risk factor for VTE. 31,32 The concomitant reduction of thrombin generation (both TGA-AUC and TGA-PK) recorded immediately after the run is also suggestive of a blood coagulation activation during the prolonged physical effort, reflected by the relative exhaustion of thrombin generation potential immediately after the run.…”

Section: Discussionmentioning

confidence: 57%

“…D-dimer is a fibrin degradation product, whose concentration is always increased in blood after activation of fibrinolysis and degradation of stabilized fibrin. 30 Increased D-dimer values in plasma reliably mirror recent clot generation and subsequent fibrinolysis. Therefore, the observation of up to twofold increased D-dimer values both immediately and 3 hours after may be considered a clear sign of blood coagulation activation during endurance exercise, but it is also possibly counterbalanced by activation of fibrinolysis.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Prothrombotic State Induced by Middle-Distance Endurance Exercise in Middle-Aged Athletes

Lippi

Salvagno

Tarperi

et al. 2018

Semin Thromb Hemost

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Since the impact of possible prothrombotic factors on blood coagulation resulting from exercise remains elusive, this study investigated the acute effects of middle-distance endurance running on blood coagulation parameters in middle-aged athletes. The study population consisted of 33 male endurance runners who were engaged in a 21.1 km run under competitive conditions. Blood samples were collected before the run, immediately after the run, and 3 hours after run completion. Samples were assessed for activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen, D-dimer, factor VIII (FVIII), von Willebrand factor antigen (VWF:Ag), endogenous thrombin potential (area under the curve of thrombin generation [TGA-AUC]), and peak thrombin generation (TGA-PK). Post-run variations were expressed as delta (Δ). At baseline, APTT was found to be significantly associated with ABO blood group, VWF:Ag, and FVIII; fibrinogen with age; VWF:Ag with BMI, training regimen, and ABO blood group; APTT with FVIII; FVIII with VWF:Ag and ABO blood group; APTT with VWF:Ag; and TGA-PK with ABO blood group, PT, and TGA-AUC. Immediately after the run, statistically significant increases were observed for PT, D-dimer, VWF:Ag, and FVIII, while statistically significant reductions could be observed for APTT, TGA-AUC, and TGA-PK. Fibrinogen values remained unchanged. Significant correlations were observed between Δ VWF:Ag and Δ FVIII, Δ APTT and Δ VWF:Ag, Δ APTT and Δ FVIII, Δ TGA-AUC and Δ TGA-PK, and between Δ D-dimer and Δ TGA-AUC and Δ TGA-PK. No Δ variation was associated with running time. The results of this study seemingly suggest that middle-distance competitive running may evoke several prothrombotic changes in blood coagulation.

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Section: Discussionmentioning

confidence: 57%

Section: Discussionmentioning

confidence: 99%

Prothrombotic State Induced by Middle-Distance Endurance Exercise in Middle-Aged Athletes

Lippi

Salvagno

Tarperi

et al. 2018

Semin Thromb Hemost

Self Cite

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“…D‐dimer is detected and quantified in whole blood, plasma, or serum using monoclonal antibodies that recognize a specific epitope on cross‐linked D‐dimer molecules that are otherwise absent on the D‐domain of fibrinogen and fibrin monomers that are noncross‐linked . At least 30 commercial D‐dimer assays are available, but there are three general types: enzyme‐linked immunosorbent assays (ELISA), immunofluorescent assays, and latex agglutination assays . Each of these test methods has its own specific considerations and limitations, which has been thoroughly reviewed elsewhere .…”

Section: Assay Methods and Technical Aspectsmentioning

confidence: 99%

“…At least 30 commercial D‐dimer assays are available, but there are three general types: enzyme‐linked immunosorbent assays (ELISA), immunofluorescent assays, and latex agglutination assays . Each of these test methods has its own specific considerations and limitations, which has been thoroughly reviewed elsewhere . The Vidas D‐dimer assay, a widely used method, reportedly shows no interference from heparin, bilirubin, hemoglobin, fibrin degradation products, or plasma turbidity .…”

Section: Assay Methods and Technical Aspectsmentioning

confidence: 99%

The D‐dimer assay

2019

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D-dimer is an indirect marker of fibrinolysis and fibrin turnover; this molecule exhibits unique properties as a biological marker of hemostatic abnormalities as well as an indicator of intravascular thrombosis. D-dimer is a soluble fibrin degradation product that results from the systematic degradation of vascular thrombi through the fibrinolytic mechanism. Because of this, the D-dimer serves as a valuable marker of activation of coagulation and fibrinolysis in a number of clinical scenarios. Most commonly, D-dimer has been extensively investigated for excluding the diagnosis of venous thromboembolism (VTE) and is used routinely for this indication. In addition, D-dimer has been evaluated for determining the optimal duration of anticoagulation in VTE patients, for diagnosing and monitoring disseminated intravascular coagulation, and for monitoring other conditions in which the patient is at high risk of bleeding or thrombosis. Limitations of the assay include D-dimer elevation in a constellation of clinical scenarios (age, pregnancy, and cancer) and lack of clinical standardization.

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“…The reduction of interlaboratory variation in INR reporting translates in the true clinical goal, which is to reduce INR value variability in patients receiving oral vitamin K antagonist anticoagulants, who might be tested at different sites and times, according to a truly patient-centered approach. Similar approaches have been used for harmonizing the results of other coagulation tests, including D-dimer [48]. In the field of autoimmunity, harmonization initiatives have been promoted as standardization still represents a challenging goal.…”

Section: Harmonization In Laboratory Medicine: Not Only Clinical Chemmentioning

confidence: 99%

Harmonization in laboratory medicine: more than clinical chemistry?

Plebani

2017

Clinical Chemistry and Laboratory Medicine (CCLM)

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Abstract:The goal of harmonizing laboratory information is to contribute to quality in patient care, ultimately improving upon patient outcomes and safety. The main focus of harmonization and standardization initiatives has been on analytical processes within the laboratory walls, clinical chemistry tests in particular. However, two major evidences obtained in recent years show that harmonization should be promoted not only in the analytical phase but also in all steps of the testing process, encompassing the entire field of laboratory medicine, including innovative areas (e.g. "omics") rather than just conventional clinical chemistry tests. A large body of evidence demonstrates the vulnerability of the extra-analytical phases of the testing cycle. Because only "good biological samples" can assure good analytical quality, a closer interconnection between the different phases of the cycle is needed. In order to provide reliable and accurate laboratory information, harmonization activities should cover all steps of the cycle from the "pre-preanalytical" phase (right choice of test at right time for right patient) through the analytical steps (right results with right report) to the "post-post-analytical" steps (right and timely acknowledgment of laboratory information, right interpretation and utilization with any necessary advice as to what to do next with the information provided). In addition, modern clinical laboratories are performing a broad menu of hundreds of tests, covering both traditional and innovative subspecialties of the discipline. In addition, according to a centered viewpoint, harmonization initiatives should not be addressed exclusively to clinical chemistry tests but should also include all areas of laboratory medicine.

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D-Dimer Testing: Laboratory Aspects and Current Issues

Cited by 65 publications

References 56 publications

Prothrombotic State Induced by Middle-Distance Endurance Exercise in Middle-Aged Athletes

Prothrombotic State Induced by Middle-Distance Endurance Exercise in Middle-Aged Athletes

The D‐dimer assay

Harmonization in laboratory medicine: more than clinical chemistry?

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