Bruno Pougault։ D-Dimer in Infection and Suspected VTE
Bruno Pougault, Global Marketing Hemostasis Product Manager at HORIBA ABX SAS, shared a post on LinkedIn:
“Infection plus high D-dimer equals thrombosis?
Not necessarily.
Infection and systemic inflammation can activate coagulation and increase D-dimer, even in the absence of DVT or pulmonary embolism.
And this creates a real diagnostic challenge.
So, what is the right biomarker when VTE is suspected in an infected patient?
After reviewing the literature and recommendations/scientific guidance from ISTH, BSH, SFH and ESC, my key takeaway is:
- D-dimer remains the established biomarker, but its role needs to be understood correctly.
- Excellent contribution to VTE exclusion within validated diagnostic algorithms.
- Insufficient specificity to confirm thrombosis, particularly when inflammation or infection is already increasing fibrin turnover.
The ESC pulmonary embolism guidance, for example, integrates clinical pre-test probability plus D-dimer plus imaging when indicated, rather than using D-dimer as a stand-alone diagnostic test.
And there is another challenge:
D-dimer assays are not fully harmonized.
Significant inter-assay variability remains, particularly around VTE exclusion thresholds.
This leads to an interesting question:
Instead of searching for a replacement for D-dimer, should we search for the best biomarker to complement it in patients with infection?
Soluble fibrin?
Fibrin monomers?
Markers of thrombin generation?
A multimarker algorithm?
What would you investigate first?
Based on a review of the scientific literature and analysis of available guidance and recommendations from ISTH, BSH, SFH, ESC and other relevant scientific organizations. For scientific discussion only.”
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