How we manage a high D-dimer.
Review published in Haematologica (2024)
Abstract
D-dimer, a soluble fibrin degradation product that originates from plasmin-induced degradation of cross-linked fibrin, is an important biomarker of coagulation activation and secondary fibrinolysis that is routinely used to rule out venous thromboembolism (VTE), and to evaluate the risk of VTE recurrence, as well as the optimal duration of anticoagulant therapy. Besides VTE, D-dimer may be high due to physiologic conditions, including aging, pregnancy, and strenuous physical activity. In addition, several disorders have been associated with increased D-dimer levels, ranging from disseminated intravascular coagulation to infectious diseases and cancers. Thus, it is far from unusual for hematologists to have to deal with ambulatory individuals with increased D-dimer without signs or symptoms of thrombus formation. This narrative review is dedicated to the management of these cases by the hematologist.
Abstract sourced from PubMed (NCBI) for the cited record. See the original publication for the authoritative version.
Summary
D-dimer, a soluble fibrin degradation product that originates from plasmin-induced degradation of cross-linked fibrin, is an important biomarker of coagulation activation and secondary fibrinolysis that is routinely used to rule out venous thromboembolism (VTE), and to evaluate the risk of VTE recurrence, as well as the optimal duration of anticoagulant therapy.
Why This Matters for Hirudotherapy
This narrative review addresses how hematologists should manage ambulatory patients found to have an elevated D-dimer without signs or symptoms of thrombosis, noting that D-dimer is a plasmin-derived fibrin-degradation product used to rule out venous thromboembolism and gauge recurrence risk, yet can also rise from aging, pregnancy, strenuous activity, disseminated intravascular coagulation, infection, and cancer. For hirudotherapy this is useful context on the fibrinolytic axis that medicinal-leech saliva engages: leech-derived molecules act on fibrin and the clotting cascade, so understanding D-dimer as a fibrinolysis/coagulation-activation biomarker frames how clinicians interpret a hemostatic system that leech secretome components also modulate. Caveat: this is a non-systematic narrative review summarizing the authors' clinical approach rather than primary or pooled data, and it concerns diagnostic interpretation of a biomarker, with no direct study of leeches or hirudotherapy.
Citation
Added to ASH library: May 28, 2026 · Site last updated: June 18, 2026