D-dimer and COVID-19: A Prognostic Indicator or Pitfall?

[mktsgm]

TL;DR Summary

D-dimer indicates that fibrinolysis is going on. Is it not beneficial?

D-dimer is a fibrin degradation product, a small protein fragment present in the blood after a blood clot is degraded by fibrinolysis.

So, the presence of D-dimer indicates that fibrinolysis is active in the body. Fibrinolysis should be considered beneficial against the backdrop of the danger of circulating clots.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7357271/

This paper indicates under the heading - Discussion,

inflammatory settings, ... induce an upregulation of plasminogen activator inhibitor (PAI)-1 with consequent impairment of fibrinolysis.

1. Hence, upregulation of fibrinolysis should be viewed favorably. Instead of viewing D-dimer elevation (consequent on upregulation of fibrinolysis) as an indicator that the body is trying to wriggle out of coagulation, the D-dimer elevation under Covid condition is considered as not good for prognosis. Why? Shouldn't it be the other way round?
2. Also, how to interpret thrombocytopenia with elevated D-dimer in circulation?

Thanks,

 

[jim mcnamara]

high D-dimer at admission was an independent predictor for mortality in COVID-19 patients from Wuhan. Patients with a D-dimer ≥2.0 μg/ml had a much higher mortality incidence than those with levels ≤2.0 μg/ml (HR 51.5),1 where the HR was 18.4 in D-dimers ≥1.0 μg/ml.

From:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7448362/

You make your own determination - I'm staying out - this is purely an attending physician's call. Notice "pitfall" in the title of the clinical paper - PF is not the place to critique clinical decisions.

So, time to close the thread...