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 Blood, 26 March 2009, Vol. 113, No. 13, pp. 2878-2887.
Prepublished online as a Blood First Edition Paper on November 13, 2008; DOI 10.1182/blood-2008-06-165845.

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Submitted June 30, 2008
Accepted October 30, 2008

D-dimer antigen: Current concepts and future prospects

Soheir S. Adam*, Nigel S. Key, and Charles S. Greenberg

University of North Carolina, Chapel Hill, NC, United States
Duke University Medical Center, Durham, NC, United States

* Corresponding author; email: soheir_adam{at}med.unc.edu.

The D-dimer antigen is a unique marker of fibrin degradation that is formed by the sequential action of three enzymes: thrombin, factor XIIIa and plasmin. First, thrombin cleaves fibrinogen producing fibrin monomers which polymerize and serve as a template for factor XIIIa and plasmin formation. Second, thrombin activates plasma factor XIII bound to fibrin polymers to produce the active transglutaminase, factor XIIIa. Factor XIIIa catalyzes the formation of covalent bonds between D-domains in the polymerized fibrin. Finally, plasmin degrades the crosslinked fibrin to release fibrin degradation products and expose the D-dimer antigen. D-dimer antigen can exist on fibrin degradation products derived from soluble fibrin before its incorporation into a fibrin gel, or after the fibrin clot has been degraded by plasmin. The clinical utility of D-dimer measurement has been established in some scenarios, most notably for the exclusion of VTE. This paper consists of two sections: in the first, the dynamics of D-dimer antigen formation is discussed and an overview of commercially available D-dimer assays is provided. The second section reviews available evidence for the clinical utilization of D-dimer antigen measurement in VTE, as well as emerging areas of D-dimer utilization as a marker of coagulation activation in other clinical settings.


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