D-dimer is a fragment from a fibrin protein that glues platelets together into a blood clot. The body separates platelets from fibrinogen fragments during fibrinolysis, the process by which a blood clot breaks down. One of those protein fragments is D-dimer. The body constantly forms little blood clots, so there’s always a “normal” or baseline D-dimer level in the blood, but it’s minimal. The only way to spot high D-dimer levels is from a blood test. If, on a blood test, D-dimer levels are higher than normal, this could mean there could be a blood clot (thrombus) lodged in a blood vessel. However, test results sometimes show that D-dimer levels are high, but there is no blood clot. Elevated D-dimer levels don’t feel or look like anything and do not cause any symptoms unless a person has a serious blood clotting disorder such as a pulmonary embolism, deep vein thrombosis (DVT), stroke, COVID-19, or blood clots throughout the circulatory system. Medical conditions, such as pregnancy, obesity, and infections, can also raise D-dimer levels. In those cases, people won’t know they have elevated D-dimer levels until they have a blood test.
Elevated D-dimer levels are a common symptom that may be caused by serious blood clot problems such as venous thromboembolism (VTE), stroke, or disseminated intravascular coagulation (DIC). Elevated D-dimer levels also occur with advanced age, immobility, pregnancy, obesity, cancer, heart disease, injury, recent surgery, smoking, autoimmune diseases, infection, and sepsis.
Elevated D-dimer levels may require immediate medical attention if caused by a blood clot.
Elevated D-dimer levels generally require treatment if blood clots are the cause. D-dimer levels typically return to normal with treatment within a variable timeframe, depending on the blood clot and its severity.
Treatments for elevated D-dimer levels vary by cause. Blood thinners, clot-dissolvers, and endoscopic surgery treat blood clots. Read more about treatments for deep vein thrombosis here.
Elevated D-dimer levels can not be managed with natural remedies, supplements, or home remedies.
Save on prescriptions for elevated D-dimer levels with a SingleCare prescription discount card.
The most significant causes of elevated D-dimer levels are serious blood clot problems such as:
Deep vein thrombosis
Pulmonary embolism
Stroke
Disseminated intravascular coagulation (DIC)
DIC involves blood clots forming throughout the circulatory system. It’s an uncommon and life-threatening condition that can be caused by:
Trauma
Surgery
Cancer
Liver disease
Severe immune reactions, including the body’s immune reaction to severe COVID-19 infection
Snake or spider venom
High D-dimer levels are also associated with other risk factors, but healthcare professionals consider these high D-dimer levels false positives. Though these conditions are caused by elevated D-dimer levels, they are not from a blood clotting disorder and do not require medical treatment. These conditions include:
Advanced age
Obesity
Pregnancy
Childbirth
Cigarette smoking
Injury
Recent surgery
Infection
Heart disease
Autoimmune disorders such as rheumatoid arthritis
RELATED: What causes blood clots? Diagnosis, prevention, and treatments,
People will learn they have an elevated D-dimer level from a healthcare professional. Most people will already have been told that a D-dimer assay was drawn because there’s a risk that they have a blood clot. Before getting test results, a blood sample will be drawn by a phlebotomist and sent to a laboratory for testing. Rarely, the mishandling of the blood draw or the blood could result in a falsely elevated D-dimer test result.
D-dimer tests are rapid and inexpensive, so they’re a great tool for determining if someone needs more testing. However, they’re not very specific to blood clots. Because of this low specificity, the D-dimer test should only be performed on patients at risk for blood clots because otherwise, the results have a high probability of returning false positives. In those cases, people will have elevated D-dimer but no blood clots.
People with obvious symptoms of a blood clot will probably not be given a D-dimer test because it won’t offer more information. Instead, they will be given other blood and imaging tests to verify there’s a blood clot and find its location.
Blood clot symptoms that require immediate medical attention include:
Symptoms of DVT include leg swelling, leg pain, leg warmth, and red skin on one leg
Shortness of breath, difficulty breathing, chest pain, back pain, coughing, and racing heartbeats are signs of a blood clot in the lung’s arteries (pulmonary embolism)
Stroke is signaled by the sudden onset of symptoms such as confusion, weakness, or numbness on one side of the body—other symptoms include sudden loss of coordination, confusion, inability to speak, inability to walk normally, lightheadedness, dizziness, and severe headache
Bleeding (nosebleeds, gum bleeding, skin bruising, wound bleeding), blood in the stool, blood in the urine, bruising, and chest pain are symptoms that blood clots are forming throughout the circulatory system (disseminated intravascular coagulation)
If any cluster of these symptoms is experienced, go to an emergency department for immediate evaluation.
RELATED: How to recognize the signs of a stroke
If there is a risk of a blood clot, the clinician will use more specific diagnostic methods than a D-dimer assay to make a diagnosis. These will include:
Blood tests to spot more specific markers of a blood clot
A Doppler ultrasound scan of the legs to find a blood clot in the leg
A chest CT angiography or a ventilation/perfusion (V/Q) scan to find a blood clot in the lungs
A CT scan or MRI of the head to find a blood clot in the brain
If there are no symptoms or any risk of a blood clot, the clinician will probably indicate that the elevated D-dimer levels are probably nothing to worry about. Still, the clinician may do a workup to make sure. This will include:
A medical history
A physical examination
Blood tests to identify other markers of a blood clotting problem
Elevated D-dimer levels are not contagious. In some cases, high D-dimer levels may well be associated with infections such as COVID-19. However, in those cases, people will know they have an infection. For COVID-19, blood clotting and elevated D-dimer levels don’t occur until someone is severely ill and needs emergency or intensive care.
D-dimer levels will last for as long as the underlying cause. For people with blood clots, it will last until the blood stops clotting and the clots are fully dissolved. An elevated D-dimer may be a long-term condition for false positives, but it’s not harmful.
There are no elevated D-dimer levels treatments because elevated D-dimer in the blood does not do any harm. However, blood clots are a serious and life-threatening disorder. If elevated D-dimer levels result from a blood clot, clinicians will treat that blood clot and try to lower the risk of other blood clots forming. Treatments will vary depending on the location of the blood clot.
Treatments for deep vein thrombosis typically involve:
Blood thinner medications, including antithrombin activators (heparins), vitamin K antagonists such as warfarin, and oral anticoagulants
Clot-dissolving medications called thrombolytics
A pulmonary embolism is primarily treated with:
Blood thinners
Thrombolytics
Catheter thrombolysis (in which blood clotting dissolvers are placed directly on the blood clot using a catheter)
Thrombectomy (surgical removal of the blood clot)
Surgical installation of a vena cava filter to prevent new blood clots from entering the heart and traveling to the lung’s arteries
Stabilizing vital signs: breathing, blood pressure, temperature, and blood sugar
Thrombolytics, usually intravenous alteplase
Thrombectomy
Antiplatelet treatment with aspirin
Healthcare professionals treat disseminated intravascular coagulation by focusing on the underlying cause. If blood clotting is severe, the medical team will administer blood thinners.
RELATED: Anticoagulants: uses, common brands, and safety info
When D-dimer levels are associated with a blood clot, serious illness, or injury that causes blood clots, healthcare providers will treat that underlying condition. D-dimer levels will return to normal when the clot dissolves and no new clots form. However, many people have elevated D-dimer levels without blood clots. D-dimer levels aren’t something to worry about if they are not severely elevated. If they’re due to a controllable issue like obesity or smoking, correcting that problem may return D-dimer levels to normal.
Although D-dimer levels don’t cause symptoms, blood clots frequently do. The symptoms will depend on where the blood clot forms, but there’s often little doubt that something bad is happening. The pain can be severe. It may be hard to move. If it’s in the lungs, it may be hard to catch your breath. If it’s in the brain, there’s a whole lot that goes wrong in an instant. If any serious symptoms like this are experienced, every minute counts. Even if the blood clot is in the leg, it could travel to the lungs in a short time. Go to the emergency department for immediate evaluation and treatment.
COVID-19 and D-dimer: Frequently Asked Questions, American Society of Hematology
D-dimer, StatPearls
D-dimer test, Cleveland Clinic
Acute stroke, StatPearls
Anticoagulants: uses, common brands, and safety info, SingleCare
Deep vein thrombosis treatments and medications, SingleCare
Disseminated intravascular coagulation, StatPearls
Pulmonary embolism symptoms: what are the early signs of pulmonary embolism?, SingleCare
Thrombolytics: uses, common brands, and safety info, SingleCare
Factors associated with positive D-dimer results in patients evaluated for pulmonary embolism, Academic Emergency Medicine
How to recognize and manage COVID-19-associated coagulopathy, American Society of Hematology
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