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The D-dimer is a stable termination product of fibrin degradation. It was introduced as a biomarker of coagulation activation in the early 1970s and first evaluated as a test to exclude venous thromboembolism (VTE) in the 1980s.1 It has since been widely adopted into diagnostic care pathways across the world, despite well-documented issues with variation across laboratory assays and reporting units.2 D-dimer is often viewed as a dichotomous test (positive or negative) based on the standard threshold of 500 ng/mL fibrinogen equivalent units (FEUs) used in original derivation studies, despite being a continuous variable.3 Like so many tests in medicine, there is potential for more effective use.