Objective <p>D-dimer predicts survival in patients with digestive cancers. However, comprehensive analysis focused on gastric cancer patients is lacking. This meta-analysis aimed to investigate the association of D-dimer with survival in gastric cancer patients.</p> Methods <p>Studies exploring the relationship of D-dimer with the prognosis of gastric cancer patients were included. Web of Science, PubMed, Cochrane Library, and EMBASE databases were used to identify studies until October 1st, 2024. The methodological index for non-randomized studies (MINORS) tool was used for quality assessment. The Begg’s test was applied to evaluate publication bias. Hazard ratio (HR), risk ratio (RR), and 95% confidence interval (CI), were used to calculate the outcomes.</p> Results <p>This meta-analysis contained 10 studies with 4746 gastric cancer patients. High D-dimer level was related to unsatisfactory overall survival (OS) [HR (95% CI): 1.44 (1.27, 1.64), <i>P</i> &lt; 0.001] and disease-free survival (DFS)/progression-free survival (PFS) [HR (95% CI): 1.79 (1.50, 2.13), <i>P</i> &lt; 0.001]. Subgroup analyses disclosed that in studies conducted in China, prospective studies, retrospective studies, studies with a sample size of ≤ median value (335.5), and studies with a sample size of &gt; median value, high D-dimer level was linked to short OS and DFS/PFS (all <i>P</i> &lt; 0.01). The association of D-dimer with OS and DFS/PFS was not found in studies conducted in Korea (both <i>P</i> &gt; 0.05). High D-dimer level was linked to lymph node metastasis [RR (95% CI): 1.37 (1.14, 1.66), <i>P</i> = 0.001]. However, D-dimer was not related to distant metastasis [RR (95% CI): 1.06 (0.76, 1.49), <i>P</i> = 0.718]. No publication bias existed, and the stability of this meta-analysis was acceptable.</p> Conclusion <p>High D-dimer level is associated with unsatisfactory survival and lymph node metastasis in gastric cancer patients.</p>