Fibrinolysis

May 2020 Quick Question: D-dimer Results

Our May, 2020 Quick Question, which attracted 70 responses, was, “What assay does your lab use to monitor DIC?” The answers were somewhat predictable, only with a twist. They were: a. FDP: 1% [1] b. D-dimer: 69% [48] c. FDP & D-dimer: 30% [21] d. Other, please comment: 0 These findings are interesting because most […]

May 2020 Quick Question: D-dimer

Colleague Dave McGlasson commented that some of the Covid articles from China reported D-dimer and fibrin degradation products (FDPs) on their critically ill patients, prompting our May, 2020 Quick Question, What assay do you use to monitor disseminated intravascular coagulation (DIC)? If you answer “neither,” please indicate in the comments section if you use one […]

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

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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.

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