I reviewed the article “Systematic Review and Meta-Analysis of the Association between D-dimer and Rheumatic Diseases” and identified a significant problem with the high heterogeneity (I² = 86.1%) reported in the meta-analysis. The authors did not adequately investigate the sources of this heterogeneity, raising concerns about the reliability and applicability of the results. I recommend further analysis to identify and address sources of heterogeneity to improve the robustness and clinical relevance of the study.