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Diagnosis of Pulmonary Embolism — Simplicity in a Complex Field

A negative D-dimer result can exclude PE even in patients with prior thromboembolic events.

Use of D-dimer testing has revolutionized the management of deep vein thrombosis and pulmonary embolism. Unfortunately, many patients (pregnant women, the elderly, postoperative patients, cancer patients, and those with prior PE) can have a positive D-dimer test even without venous thromboembolism (VTE). These authors assessed the usefulness of D-dimer testing in patients with suspected PE who had prior VTE.

They analyzed data from 1721 patients enrolled in two prospective, multicenter, cohort studies who presented to an emergency department or primary care physician with suspected PE. All patients underwent ELISA D-dimer testing and standard diagnostic workup and then were followed up after 3 months.

Overall, 17.9% of patients had had previous VTE. D-dimer results were negative in 15.9% of patients with previous VTE and in 32.7% of patients without prior VTE. Of importance, no patient with a negative D-dimer test had a thromboembolic event during 3-month follow-up, regardless of VTE history.

Comment: These findings are encouraging. In patients with prior VTE, who by current definitions are not "low risk," a negative D-dimer result can safely rule out PE. The sensitivity of D-dimer testing varies greatly with the type of assay, however, with the ELISA tests being the most sensitive.

— J. Stephen Bohan, MS, MD, FACP, FACEP

Published in Journal Watch Emergency Medicine March 28, 2006

Citation(s):

Le Gal G et al. Value of D-dimer testing for the exclusion of pulmonary embolism in patients with previous venous thromboembolism. Arch Intern Med 2006 Jan 23; 166:176-80.

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• Medline abstract (Free)

Moores LK. Diagnosis and management of pulmonary embolism: Are we moving toward an outcome standard? Arch Intern Med 2006 Jan 23; 166:147-8.

• Original article (Subscription may be required)
• Medline abstract (Free)