D-dimer

A normal D-dimer is considered less than 0.50. A positive D-dimer is 0.50 or greater.

D-dimer (a specific fibrin degradation product): high levels are associated with Deep-vein thrombosis and Pulmonary Embolism. ¹⁾

A negative D-dimer test reliably excludes PE in patients with a low clinical probability of PE ²⁾ or in those with nondiagnostic Ventilation/perfusion scan ³⁾.

D-dimer showed a sensitivity of 97.1%, specificity of 91.2%, a negative predictive value of 99.6%, and a positive predictive value of 55.7% for cerebral venous sinus thrombosis ⁴⁾.

A normal D-dimer level by a sensitive radioimmunoassay or ELISA may help identify patients with a low probability of CVT (Level II ⁵⁾.

Okamoto et al. investigated the appropriate D-dimer cutoff value for each brain tumor type for acute or subacute Deep-Vein Thrombosis (DVT) following transcranial brain tumor surgery. In this single-center retrospective study, a cumulative total of 128 patients who underwent transcranial brain tumor surgery were enrolled and classified into the glioma group, the other intracranial malignant tumor group, and the intracranial benign tumor group. Venous ultrasonography was performed if the D-dimer plasma levels were positive (≥1 μg/mL) before surgery and on postoperative day (POD) 3 or 7.Of the 128 cases, DVT developed in 32 (25.0%). Among those, acute or subacute DVT was diagnosed in 22 cases on POD 3 and in 8 cases on POD 7. Compared with DVT-negative cases on POD 3, acute or subacute DVT-positive cases on POD 3 revealed a significant increase in the D-dimer level in all groups combined and in the benign tumor group but not in the glioma group. With regard to DVT on POD 3 in all groups, the receiver operating characteristic curve for the D-dimer level on POD 3 demonstrated a cutoff value of 3.3 μg/mL (sensitivity [0.636] and specificity [0.750]). However, if this cutoff value was used in practice, eight cases would be false-negative with a minimum D-dimer level of 1.5 μg/mL.The D-dimer cutoff value for acute or subacute DVT on POD 3 could be set to 3.3 μg/mL; however, the setting resulted in several false-negative cases. Practically, 1.5 μg/mL of the D-dimer cutoff value on POD 3 might be appropriate to avoid false-negative results ⁶⁾.

D-dimer levels indicate venous thromboembolism with a high degree of sensitivity and specificity in patients who have undergone craniotomy.

Elevated D-dimer levels at admission were associated with short-term and long-term mortality in aneurysmal subarachnoid hemorrhage. This biomarker could be considered in future risk nomograms for long-term outcomes and might support future management decisions ⁷⁾.

Previous studies have shown excessive D-dimer level was considered to be a risk factor of thromboembolic disease after spinal surgery ⁸⁾ ⁹⁾ ¹⁰⁾.

Guo et al found that D-dimer level was closely associated with the development of Deep-vein thrombosis after craniotomy. The peak plasma D-dimer level occurred on the 3rd day after craniotomy, and the mean plasma D-dimer level gradually decreased from 3 to 14 days after surgery. This phenomena was consistent with the timing of development of Deep-vein thrombosis, because 65.6% of Deep-vein thrombosiss were detected within 1 week after surgery; however, whether D-dimer level can be used as an indicator of Deep-vein thrombosis requires further exploration in future ¹¹⁾.

¹⁾ , ³⁾

Ginsberg JS, Wells PS, Kearon C, et al. Sensitivity and Specificity of a Rapid Whole-Blood Assay for Ddimer in the Diagnosis of Pulmonary Embolism. Ann Intern Med. 1998; 129:1006–1011

²⁾

Wells PS, Ginsberg JS, Anderson DR, et al. Use of a Clinical Model for Safe Management of Patients with Suspected Pulmonary Embolism. Ann Intern Med. 1998; 129:997–1005

⁴⁾

Kosinski CM, Mull M, Schwarz M, et al. Do normal D-dimer levels reliably exclude cerebral sinus thrombosis? Stroke. 2004; 35:2820–2825

⁵⁾

Saposnik G, Barinagarrementeria F, Brown RD,Jr, et al. Diagnosis and management of cerebral venous thrombosis: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011; 42:1158–1192

⁶⁾

Okamoto E, Ishikawa E, Kino H, Kohzuki H, Sugii N, Naito H, Hara T, Homma S, Matsuda M, Tsurubuchi T, Ishikawa T, Kawakami Y, Akutsu H. Perioperative Deep-Vein Thrombosis and D-dimer Measurement in Patients with Brain Tumor. Neurol Med Chir (Tokyo). 2022 Feb 16. doi: 10.2176/jns-nmc.2021-0339. Epub ahead of print. PMID: 35173104.

⁷⁾

Fang F, Wang P, Yao W, Wang X, Zhang Y, Chong W, Hai Y, You C, Jiang Y. Association between D-dimer levels and long-term mortality in patients with aneurysmal subarachnoid hemorrhage. Neurosurg Focus. 2022 Mar;52(3):E8. doi: 10.3171/2021.12.FOCUS21512. PMID: 35231898.

⁸⁾

Si WT, Zhang HG, Sun YB, Bai Y. Correlation analysis on plasma D-dimer level with deep venous thrombosis after spinal surgery. Zhongguo Gu Shang. 2014;27:405–8.

⁹⁾

Yoshiiwa T, Miyazaki M, Takita C, Itonaga I, Tsumura H. Analysis of measured D-dimer levels for detection of deep venous thrombosis and pulmonary embolism after spinal surgery. J Spinal Disord Tech. 2011;24:E35–9.

¹⁰⁾

Hamidi S, Riazi M. Cutoff values of plasma d-dimer level in patients with diagnosis of the venous thromboembolism after elective spinal surgery. Asian Spine J. 2015 Apr;9(2):232-8. doi: 10.4184/asj.2015.9.2.232. Epub 2015 Apr 15. PubMed PMID: 25901235; PubMed Central PMCID: PMC4404538.

¹¹⁾

Guo F, Shashikiran T, Chen X, Yang L, Liu X, Song L. Clinical features and risk factor analysis for lower extremity deep venous thrombosis in Chinese neurosurgical patients. J Neurosci Rural Pract. 2015 Oct-Dec;6(4):471-6. doi: 10.4103/0976-3147.169801. PubMed PMID: 26752303; PubMed Central PMCID: PMC4692000.