Contemporary Use and Clinical Interpretation of D-Dimer for Venous Thromboembolism: A Structured Narrative Review

D-dimerVenous thromboembolism Diagnostic algorithm Clinical probability D-dimer testing has long been established as a cornerstone in the diagnostic evaluation of suspected venous thromboembolism (VTE), offering a high negative predictive value when combined with clinical probability assessment.However, its performance and interpretation remain challenging in real-world practice, particularly among patients with high baseline thrombotic risk or a history of previous deep vein thrombosis (DVT).This review summarizes recent advances and practice patterns concerning Ddimer-based diagnostic algorithms, with an emphasis on their application in complex clinical settings.Recent evidence demonstrates that D-dimer retains diagnostic value in low-and intermediate-probability patients but loses specificity in the presence of active malignancy, postoperative inflammation, or chronic vascular disease.In individuals with prior DVT, baseline elevation and residual thrombus often lead to false-positive results, underscoring the need for integrated diagnostic strategies combining D-dimer testing with compression ultrasonography and validated clinical scores.Despite the availability of refined approaches, such as age-adjusted or pretest-probability-adjusted thresholds, their implementation in routine care remains limited.Real-world data reveal frequent test overuse, variable assay interpretation, and inconsistent adherence to guidelinerecommended diagnostic pathways.Understanding these limitations and contextual factors is essential to enhance diagnostic precision and resource utilization.Future directions include improved algorithm adherence through electronic decision-support systems, harmonization of assay reporting standards, and further validation of D-dimerbased models in diverse patient populations.