We would like to thank Gonzaga and de Alencas for their letter. Their comments on our review article “How we manage a high D-dimer” recently published in Haema-tologica1 are reasonable and well circumstantiated. The main objective of our review was to simplify the particularly complex topic of increased D-dimer levels in order to provide a handy tool for the daily clinical practice of hematologists. The authors made two comments to our narrative review. We agree with Gonzaga and de Alencas’s first comment that D-dimer may carry a high positive predictive value in selected pathological conditions characterized by a very high pre-test probability.2 However, in our review we referred (always for reasons of practicality) to the main clinical setting for which the D-dimer is used which is pulmonary embolism exclusion. In this setting, to ensure optimal patient management, an ideal D-dimer test should have very high sensitivity and a very high negative predictive value.3
Regarding the second comment on the inappropriateness and overuse of the D-dimer test in most cases, we also agree with the authors. Unfortunately, the D-dimer test has become very common practice, at least in Italy, and its use has exponentially increased over the last few years (hence the nickname “D-dimeritis”), particularly during the COVID-19 pandemic.4 It is clear, however, that an elevated D-dimer in an individual referred by the general practitioner to the hematologist cannot be ignored, but all the diagnostic procedures listed in Figure 3 of our review1 have to be implemented to rule out or diagnose the possible underlying conditions associated with an increased D-di-mer. We agree that educating general practitioners on the appropriateness of prescribing D-dimer tests is needed, but that would lead only to a mid- to long-term response.
Footnotes
- Received April 26, 2024
- Accepted May 7, 2024
Correspondence
Disclosures
PMM has received Roche, Takeda and Werfen honoraria for lectures at educational symposia. The other authors have no conflicts of interest to disclose.
Contributions
References
- Franchini M, Focosi D, Pezzo MP, Mannucci PM. How we manage a high D-dimer. Haematologica. 2024; 109(4):1035-1045. https://doi.org/10.3324/haematol.2023.283966PubMedPubMed CentralGoogle Scholar
- Koch V, Biener M, Müller-Hennessen M. Diagnostic performance of D-dimer in predicting venous thromboembolism and acute aortic dissection. Eur Heart J Acute Cardiovasc Care. 2020; 10(5):559-566. https://doi.org/10.1177/2048872620907322PubMedPubMed CentralGoogle Scholar
- Fan BE, Lippi G, Favaloro EJ. D-dimer Levels for the exclusion of pulmonary embolism: making sense of international guideline recommendations. J Thromb Haemost. 2024; 22(3):604-608. https://doi.org/10.1016/j.jtha.2023.12.015PubMedGoogle Scholar
- Thachil J, Favaloro EJ, Lippi G. D-dimers-”Normal” Levels versus Elevated Levels Due to a Range of Conditions, Including “D-dimeritis,” Inflammation, Thromboembolism, Disseminated Intravascular Coagulation, and COVID-19. Semin Thromb Hemost. 2022; 48(6):672-679. https://doi.org/10.1055/s-0042-1748193PubMedGoogle Scholar
Figures & Tables
Article Information
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.