D-Dimer Testing in Patients Taking Direct Oral Anticoagulants

Clinical Recommendations

• The American College of Chest Physicians recommends D-dimer testing as safe and valid when combined with clinical probability assessment in patients with suspected recurrent DVT 1
• The combination of unlikely pretest probability plus negative D-dimer had VTE frequency of only 0.9% during 3-month follow-up, according to the 2012 CHEST guidelines 1
• Negative sensitive D-dimer assays safely exclude recurrence with false-negative rates of 2-5%, as demonstrated by the 2012 CHEST guidelines 1
• The World Society of Emergency Surgery strongly recommends routine coagulation assays including aPTT, PT, INR, and anti-Xa levels to assess anticoagulant exposure in emergency/trauma settings 2
• The European Society of Cardiology guidelines support D-dimer use to rule out PE in outpatients, but emphasize it should not be measured in high clinical probability patients due to low negative predictive value 3
• The European Heart Journal recommends avoiding D-dimer testing in hospitalized patients on therapeutic DOACs, where the number needed to test for clinically relevant negative results is prohibitively high 3