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.
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.2023.283966Google 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/10.1177/2048872620907322Google 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.2023.12.015Google 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-0042-1748193Google Scholar
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