Beyond thrombosis: expanding the clinical spectrum of D-dimer

José E. Montelongo-Cepeda, Servicio de Hematología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León (UANL), Monterrey, Nuevo León, Mexico
Sofía I. Quezada-Ramírez, Servicio de Hematología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León (UANL), Monterrey, Nuevo León, Mexico
David Gómez-Almaguer, Servicio de Hematología, Hospital Universitario “Dr. José Eleuterio González”, Universidad Autónoma de Nuevo León (UANL), Monterrey, Nuevo León, Mexico

D-dimer (DD), a fibrin degradation product, is widely used to exclude thromboembolic events due to its high sensitivity.However, elevated DD levels can also occur in numerous non-thrombotic conditions, including infection, inflammation, malignancy, cardiovascular disease, pregnancy, aging, and even after physical exertion. In sepsis and COVID-19, DD correlateswith disease severity and mortality, while in cancer, it may reflect tumor burden and guide treatment response. DD is alsobeing integrated into risk models for ovarian cancer, aortic dissection, and infection-related outcomes. DD testing is useful,yet its interpretation can be affected by assay variability, inconsistent reference ranges, and high false-positive rates in certainpopulations. Overreliance on DD may lead to unnecessary imaging and anticoagulation, increasing risks and healthcarecosts. Accurate interpretation requires clinical context, risk assessment, and additional testing. As research expands DD’sprognostic roles, particularly in non-thrombotic conditions, clinical judgment remains vital. Future goals include integratingDD into personalized diagnostic algorithms and developing more specific thrombosis biomarkers to enhance clinical decision-making.

Keywords: D-dimer. Biomarker. Sepsis. Neoplasm.