Int J Angiol 2023; 32(04): 243-247
DOI: 10.1055/s-0042-1759819
Original Article

D-Dimer and Fibrinogen Values according to the Localization of Deep Venous Thrombosis

1   Department of Angiology, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Nejra Mlačo
2   Dom zdravlja Visoko, Bosnia and Herzegovina
Edin Begić
3   Department of Cardiology, General Hospital “Prim. Dr. Abdulah Nakas,” Sarajevo, Bosnia and Herzegovina
Mevludin Mekić
4   Department of Rheumatology, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
Alen Džubur
5   Department of Cardiology, Clinic for Heart, Blood Vessel and Rheumatic Diseases, Clinical Center University of Sarajevo, Bosnia and Herzegovina
› Author Affiliations
Funding None.


D-dimer and fibrinogen are nonspecific diagnostic biomarkers for venous thromboembolism (VTE). The aim of this article was to present the values of D-dimer and fibrinogen in relation to the anatomical localization of deep vein thrombosis (DVT). This was an observational study, which included 1,142 patients hospitalized from 2010 to 2019 at the Department of Angiology, Clinical Center University of Sarajevo. Data on gender, age, and thrombosis location were collected of all patients. Fibrinogen and D-dimer values were available for 983 and 500 patients, respectively. Thrombosis location was classified as iliofemoral (521–45.6% patients), femoral–popliteal (486–42.6% patients), isolated calf DVT (63–5.5% patients), and upper extremity DVT (UEDVT in 72–6.3% patients). A majority, 448 (89.6%), of patients had high D-dimer (the cutoff is 0.55 mg/L) and 662 (67.3%) patients had high fibrinogen (reference range: 1.8–3.8 g/L).

The highest D-dimer was detected in patients with iliofemoral DVT (mean: 10.48 mg/L), χ2 = 50.78, p = 0.00. The highest fibrinogen was detected in patients with iliofemoral DVT as well (mean 4.87 g/L), χ2 = 11.1, p = 0.01. D-dimer and fibrinogen values are significantly higher in patients iliofemoral DVT than femoral–popliteal and isolated calf DVT, and D-dimer values are significantly higher in lower extremity DVT than UEDVT, but these biomarkers cannot be used alone to discriminate between thrombosis locations. Further imaging is required.

Publication History

Article published online:
13 January 2023

© 2023. International College of Angiology. This article is published by Thieme.

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  • References

  • 1 Siegal D, Lim W. Chapter 142: Venous thromboembolism. In: Hoffman R, Benz EJ, Silberstein LE, Heslop HE, Weitz JI, Anastasi J, Salama ME, Abutalib SA, eds. Hematology. 7th ed. Amsterdam: Elsevier; 2018: 2102-2112
  • 2 Phillippe HM. Overview of venous thromboembolism. Am J Manag Care 2017; 23 (20, suppl): S376-S382
  • 3 Moresco RN, Vargas LC, Voegeli CF, Santos RC. D-dimer and its relationship to fibrinogen/fibrin degradation products (FDPs) in disorders associated with activation of coagulation or fibrinolytic systems. J Clin Lab Anal 2003; 17 (03) 77-79
  • 4 Weitz JI, Fredenburgh JC, Eikelboom JW. A test in context: D-dimer. J Am Coll Cardiol 2017; 70 (19) 2411-2420
  • 5 Klovaite J, Nordestgaard BG, Tybjærg-Hansen A, Benn M. Elevated fibrinogen levels are associated with risk of pulmonary embolism, but not with deep venous thrombosis. Am J Respir Crit Care Med 2013; 187 (03) 286-293
  • 6 Olson JD. D-dimer: an overview of hemostasis and fibrinolysis, assays, and clinical applications. Adv Clin Chem 2015; 69: 1-46
  • 7 Obradović S, Džudović B, Rusović S, Subota V, Obradović D. Gender-related differences in clinical presentation, electrocardiography signs, laboratory markers and outcome in patients with acute pulmonary embolism. Vojnosanit Pregl 2016; 73 (09) 844-849
  • 8 Dzudovic J, Dzudovic B, Subota V. et al. Differences between activities of coagulation factors after one month of therapy with different direct oral anticoagulant in pulmonary embolism patients. J Clin Pharm Ther 2019; 44 (02) 236-242
  • 9 Obradovic S, Begic E, Jankovic S. et al. Association of PC and AT levels in the early phase of STEMI treated with pPCI with LV systolic function and 6-month MACE. Acta Clin Belg 2020; DOI: 10.1080/17843286.2020.1766850.
  • 10 Stein PD, Hull RD, Patel KC. et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med 2004; 140 (08) 589-602
  • 11 Kucher N, Kohler HP, Dornhöfer T, Wallmann D, Lämmle B. Accuracy of D-dimer/fibrinogen ratio to predict pulmonary embolism: a prospective diagnostic study. J Thromb Haemost 2003; 1 (04) 708-713
  • 12 Levi M, Toh CH, Thachil J, Watson HG. British Committee for Standards in Haematology. Guidelines for the diagnosis and management of disseminated intravascular coagulation. Br J Haematol 2009; 145 (01) 24-33
  • 13 van Hylckama Vlieg A, Rosendaal FR. High levels of fibrinogen are associated with the risk of deep venous thrombosis mainly in the elderly. J Thromb Haemost 2003; 1 (12) 2677-2678
  • 14 Mazzolai L, Aboyans V, Ageno W. et al. Diagnosis and management of acute deep vein thrombosis: a joint consensus document from the European Society of Cardiology working groups of aorta and peripheral vascular diseases and pulmonary circulation and right ventricular function. Eur Heart J 2018; 39 (47) 4208-4218
  • 15 Konstantinides SV, Meyer G, Becattini C. et al; The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). 2019 ESC Guidelines for the diagnosis and management of acute pulmonary embolism developed in collaboration with the European Respiratory Society (ERS): The Task Force for the diagnosis and management of acute pulmonary embolism of the European Society of Cardiology (ESC). Eur Respir J 2019; 54 (03) 1901647
  • 16 Righini M, Galanaud JP, Guenneguez H. et al. Anticoagulant therapy for symptomatic calf deep vein thrombosis (CACTUS): a randomised, double-blind, placebo-controlled trial. Lancet Haematol 2016; 3 (12) e556-e562
  • 17 Kearon C, Akl EA, Ornelas J. et al. antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest 2016; 149 (02) 315-352
  • 18 Gaitini D. Multimodality imaging of the peripheral venous system. Int J Biomed Imaging 2007; 2007: 54616
  • 19 Olaf M, Cooney R. Deep venous thrombosis. Emerg Med Clin North Am 2017; 35 (04) 743-770
  • 20 Franco L, Giustozzi M, Agnelli G, Becattini C. Anticoagulation in patients with isolated distal deep vein thrombosis: a meta-analysis. J Thromb Haemost 2017; 15 (06) 1142-1154
  • 21 Mlaco A, Mlaco N, Bejtovic D, Dzubur A, Spuzic M. Venous thromboembolism during ten-year follow up on Clinical Center University of Sarajevo. Mater Sociomed 2019; 31 (02) 84-87
  • 22 Liu D, Peterson E, Dooner J. et al; Interdisciplinary Expert Panel on Iliofemoral Deep Vein Thrombosis (InterEPID). Diagnosis and management of iliofemoral deep vein thrombosis: clinical practice guideline. CMAJ 2015; 187 (17) 1288-1296
  • 23 Comerota AJ, Paolini D. Treatment of acute iliofemoral deep venous thrombosis: a strategy of thrombus removal. Eur J Vasc Endovasc Surg 2007; 33 (03) 351-360 , discussion 361–362
  • 24 Ortel TL, Neumann I, Ageno W. et al. American Society of Hematology 2020 guidelines for management of venous thromboembolism: treatment of deep vein thrombosis and pulmonary embolism. Blood Adv 2020; 4 (19) 4693-4738
  • 25 Singer AJ, Zheng H, Francis S. et al. D-dimer levels in VTE patients with distal and proximal clots. Am J Emerg Med 2019; 37 (01) 33-37
  • 26 Linkins LA, Takach Lapner S. Review of D-dimer testing: good, bad, and ugly. Int J Lab Hematol 2017; 39 (suppl 1): 98-103
  • 27 Pulivarthi S, Gurram MK. Effectiveness of d-dimer as a screening test for venous thromboembolism: an update. N Am J Med Sci 2014; 6 (10) 491-499
  • 28 Larsen TB, Stoffersen E, Christensen CS, Laursen B. Validity of D-dimer tests in the diagnosis of deep vein thrombosis: a prospective comparative study of three quantitative assays. J Intern Med 2002; 252 (01) 36-40
  • 29 Hochuli M, Duewell S, Frauchiger B. Quantitative d-dimer levels and the extent of venous thromboembolism in CT angiography and lower limb ultrasonography. Vasa 2007; 36 (04) 267-274
  • 30 Wuillemin WA, Korte W, Waser G, Lämmle B. Usefulness of the D-dimer/fibrinogen ratio to predict deep venous thrombosis. J Thromb Haemost 2005; 3 (02) 385-387
  • 31 Mlaco A, Begic E, Iglica A, Gojak R, Mlaco N. Values of fibrinogen in relation to segmental involvement of the venous system in patients with recurrent deep vein thrombosis. Folia Med (Plovdiv) 2019; 54: 39-43
  • 32 Tita-Nwa F, Bos A, Adjei A, Ershler WB, Longo DL, Ferrucci L. Correlates of D-dimer in older persons. Aging Clin Exp Res 2010; 22 (01) 20-23
  • 33 Blondon M, Le Gal G, Meyer G, Righini M, Robert-Ebadi H. Age-adjusted D-dimer cutoff for the diagnosis of pulmonary embolism: a cost-effectiveness analysis. J Thromb Haemost 2020; 18 (04) 865-875
  • 34 Urban K, Kirley K, Stevermer JJ. PURLs: it's time to use an age-based approach to D-dimer. J Fam Pract 2014; 63 (03) 155-158
  • 35 Schouten HJ, Geersing GJ, Koek HL. et al. Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis. BMJ 2013; 346: f2492
  • 36 Hager K, Felicetti M, Seefried G, Platt D. Fibrinogen and aging. Aging (Milano) 1994; 6 (02) 133-138
  • 37 Li T, Wang F, Peng R. et al. Sex-related differences in the association between plasma fibrinogen and non-calcified or mixed coronary atherosclerotic plaques. Biol Sex Differ 2018; 9 (01) 51
  • 38 Folsom AR, Golden SH, Boland LL, Szklo M. Association of endogenous hormones with C-reactive protein, fibrinogen, and white blood count in post-menopausal women. Eur J Epidemiol 2005; 20 (12) 1015-1022
  • 39 Canonico M, Brailly-Tabard S, Gaussem P. et al. Endogenous oestradiol as a positive correlate of plasma fibrinogen among older postmenopausal women: a population-based study (the Three-City cohort study). Clin Endocrinol (Oxf) 2012; 77 (06) 905-910
  • 40 Glueck CJ, Glueck HI, Stroop D, Speirs J, Hamer T, Tracy T. Endogenous testosterone, fibrinolysis, and coronary heart disease risk in hyperlipidemic men. J Lab Clin Med 1993; 122 (04) 412-420
  • 41 Jones RD, Nettleship JE, Kapoor D, Jones HT, Channer KS. Testosterone and atherosclerosis in aging men: purported association and clinical implications. Am J Cardiovasc Drugs 2005; 5 (03) 141-154
  • 42 Mumoli N, Mastroiacovo D, Giorgi-Pierfranceschi M. et al. Ultrasound elastography is useful to distinguish acute and chronic deep vein thrombosis. J Thromb Haemost 2018; 16 (12) 2482-2491
  • 43 Tefft A, Moss T, Stanley A, Malhotra AK. Not all deep vein thrombosis is created equal: incidence of preexisting chronic deep vein thrombosis among high-risk traumatized patients. J Trauma Acute Care Surg 2019; 86 (05) 871-873