Ask a doctor on the topic of Internal medicine

Thrombosis D-Dimers

December 11, 2017 | 30,00 EUR | answered by Nadja Struß

Hello, my question is: Last year, I was diagnosed with a thrombosis in my lower leg (non-compressible vein in the lower leg 3-4cm). Treatment with Fondaparinux was started on the same day. The following day, my D-Dimer value was taken, which was completely normal. I was told that there probably wasn't a thrombosis if the D-Dimer was normal. Another doctor suggested it may have been an old thrombosis, hence the D-Dimer, but didn't want to commit to a diagnosis as it was not their area of expertise.
Now, I have had an embolism before and do not want to experience one again. It would be good to know if the thrombosis did indeed occur, or if there was a mistake. It's human to make mistakes. Is it possible that there was an old thrombosis present (the doctor mentioned during the examination that he couldn't determine if it was fresh or old), which dissolved within three days with the injections? Shouldn't there have been a positive D-Dimer value, even with an old thrombosis? After two weeks of follow-up, there was nothing visible anymore.
What is your opinion on the statement that such small blockages typically do not need to be treated, and that I should not worry any longer? Thank you.

Nadja Struß

Dear inquirer,

A negative D-dimer value almost rules out thrombosis or embolism, but not 100%. There are many cases like yours where despite negative D-dimers in duplex ultrasound a thrombosis was seen. The reason for this is not entirely clear, possibly smaller or older thromboses may lead to this.

In general, a sonographic follow-up after 3-6 months is recommended. Usually, after the initial anticoagulation (in your case with Fondaparinux), a long-term therapy with an anticoagulant for a certain period of time is recommended. Please consult with an angiologist once again.

Best regards,

Nadja Struß