Fibrinolysis

More on D-dimer Reporting

Continuing in our D-dimer discussion, click or tap to read “Raising D-dimer Threshold Cuts Need for Chest Imaging by 30% in Suspected Pulmonary Embolism.” This article appears in the January/February issue of Clinical Laboratory News and refers to Kearon C, de Wit K, Parpia S, et al. Diagnosis of Pulmonary Embolism with d-Dimer Adjusted to […]

D-dimer Reporting Issues

Click or tap here for a January, 2020 Karen Titus CAP Today feature article on concerns around D-dimer assay reporting. The article focuses on unit variation, including FEUs versus DDUs, appropriate usage in ruling out DVT and PE, and emergency department turn-around times. Contributors include Kristin Lundy, MLS, Vermont; Drs. Andrew Goodwin, Vermont; Karen Moser, […]

High-sensitivity D-dimer?

A colleague has seen references to a “High-sensitivity” D-dimer assay. George answered he’s not heard of this, perhaps it is just a synonym for a standard D-dimer assay. If you have any experience with this, please respond to [email protected] or comment below.

Effect of High HCT on D-dimer Results

From Heather DeVries, Indiana University Medical Center. I’m seeking some advice on how to handle D-dimers in patients with elevated hematocrits. I saw a post on this subject in Fritsma Factor back in 2013. CLSI H59-A says to follow H21-A5 in general, which of course says to correct the anticoagulant volume. IL’s package insert for […]

More on D-dimer Elevated 6 Months

Here is a follow-up on yesterday’s (July 23, 2019) case study describing chronically elevated D-dimer. Our correspondent has graciously offered her permission to post her message (anonymously, of course). Another question for you. If there were a blood clot in my lungs would the CT chest scan be a definitive factor for ruling it out? […]

D-dimer Elevated 6 Months

Dear George, I am a 42 year old African American women in fairly good health. I am obese and I live a partly active life. I went to the emergency room back in January of this year for chest pain and palpitations. While there they did a D-dimer test and a chest CT scan. I […]

Therapeutic Reptilase

Ning Tang writes, Dear George, In China, a categary of hemostatic agents from snake venom named “Haemocoagulase” are widely used, basically they are the generic drugs of Reptilase®, which is produced by a Swiss company. We find that intravenous injection of this drug can cause severe hyperfibrinolysis and hypofibrinogenemia. It seems that Reptilase has been […]

Bleeding Disorders

Case Study: A Patient on Xarelto with Elevated D-dimer Results

In 2016, Dr. Louann Lawrence, New Orleans, communicated with a patient who had experienced a DVT and PE in 2014 and was being treated with Xarelto (rivaroxaban). The patient’s physician routinely ordered a D-dimer to assess the risk of a recurrence after discontinuing anticoagulant therapy. Following the physician’s instructions, the patient discontinues Xarelto for 24 […]

Anticoagulant Therapy

D-dimer Reference Range

Paul Smith writes, “I have a family member on Xarelto and his D-dimer reference range was 450 while taking Xarelto. What is the reference range? Hello, Mr. Smith, and thank you for your question. There is some mild confusion about the D-dimer reference intervals (reference ranges) because several distributors use varient methods. These methods result […]

Anticoagulant Therapy

March, 2018 Quick Question: D-dimer Controls

Here are the results of our March, 2018 Quick Question about the appropriate D-dimer controls. What controls are most valid for managing D-dimer assay precision? VTE decision point control only; 500 ng/mL FEUs 10% (3) Low end of linearity & VTE decision point: 100 and 500 ng/mL FEUs: 32% (10) Low and high ends of […]

Load more

George Fritsma is a medical laboratory scientist, educator, and author. George holds faculty appointments with Rutgers University and Michigan State University, and is a member of the International Society on Thrombosis and Hemostasis, American Association of Clinical Chemists, and American Society for Clinical Laboratory Science.

Cheat Sheets from George

Quick Question