Harmonisation of D-dimer — A call for action

Abstract

D-dimer is a stable, terminal product of fibrin degradation in plasma. In the 1970s, Gaffney and colleagues introduced the concept of D-dimer measurement as a biomarker of coagulation activation and fibrin formation [ [1] Gaffney P.J. Distinction between fibrinogen and fibrin degradation products in plasma. Clin. Chim. Acta. 1975; 65: 109-115 Crossref PubMed Scopus (51) Google Scholar ]. Since then, D-dimer has been used in the diagnostic process of various conditions, including the exclusion of venous thromboembolism, diagnostic scores for disseminated intravascular coagulation (DIC), thromboembolic risk in patients with atrial fibrillation, to help identify the cause of acute-onset chest pain (e.g., aortic aneurysm) and more recently, for the assessment of an individual's risk for venous thromboembolism recurrence after a first event. Although the D-dimer assay is a significant advancement to the pre-existing measurement of fibrin and fibrinogen degradation products [ [2] Gaffney P.J. Edgell T. Creighton-Kempsford L.J. Wheeler S. Tarelli E. Fibrin degradation product (FnDP) assays: analysis of standardization issues and target antigens in plasma. Br. J. Haematol. 1995; 90: 187-194 Crossref PubMed Scopus (60) Google Scholar ], which were hugely influenced by a number of artefacts, several issues exist with its routine use that compromise its utility. This communication, from the Fibrinolysis and DIC Standardisation Subcommittees of the ISTH and other concerned colleagues is a call for further efforts to harmonise D-dimer measurement.