How is D-dimer produced?

Updated: Nov 18, 2019
  • Author: Reka G Szigeti, MD, PhD; Chief Editor: Eric B Staros, MD  more...
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D-dimer is the degradation product of crosslinked (by factor XIII) fibrin. It reflects ongoing activation of the hemostatic system.

Upon activation of either the intrinsic or extrinsic pathway of the coagulation cascade, thrombin forms and cleaves fibrinopeptide A and B from fibrinogen, resulting in soluble fibrin monomers, which then associate and form fibrin polymers. The D domains of these fibrin polymers are crosslinked by activated factor XIII, producing an insoluble crosslinked fibrin clot.

Owing to the parallel activation of the fibrinolytic system to maintain proper balance between coagulation and fibrinolysis, plasmin, the end product of the fibrinolytic system, cleaves insoluble fibrin polymers, resulting in the production of fibrin degradation products (FDPs). If the polymers were crosslinked between two D domains (hence the name) of the fibrinopeptides, D-dimer is produced.

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