Higher D-Dimer Thresholds for Excluding Pulmonary Embolism: No Free Lunch?

EditorialsFebruary 2022Higher D-Dimer Thresholds for Excluding Pulmonary Embolism: No Free Lunch?Daniel J. Brotman, MDDaniel J. Brotman, MDDivision of Hospital Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MarylandAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/M21-4295 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Diagnosis of venous thromboembolism (VTE)—including pulmonary embolism (PE) and deep venous thrombosis—has been revolutionized over the last 2 decades by the development, validation, and dissemination of clinical decision rules that couple readily available clinical data with D-dimer levels to identify low-risk patients who do not require advanced imaging. But with multiple diagnostic strategies available, clinicians may be uncertain about which approach is best. One important question is whether to apply a fixed D-dimer cutoff (generally 500 μg/L) or to use a higher threshold in selected patients. Clearly, increasing the D-dimer cutoff will lower the number of patients who require radiographic ...References1. Stals MAM, Takada T, Kraaijpoel N, et al. Safety and efficiency of diagnostic strategies for ruling out pulmonary embolism in clinically relevant patient subgroups. A systematic review and individual-patient data meta-analysis. Ann Intern Med. 2022;175:244-255. doi:10.7326/M21-2625 Google Scholar2. Wells PS, Anderson DR, Rodger M, et al. Excluding pulmonary embolism at the bedside without diagnostic imaging: management of patients with suspected pulmonary embolism presenting to the emergency department by using a simple clinical model and D-dimer. Ann Intern Med. 2001;135:98-107. [PMID: 11453709] doi:10.7326/0003-4819-135-2-200107170-00010 LinkGoogle Scholar3. Le Gal G, Righini M, Roy PM, et al. 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[PMID: 30198551] doi:10.1111/bjh.15556 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: Division of Hospital Medicine, Department of Medicine, Johns Hopkins University, Baltimore, MarylandDisclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M21-4295.Corresponding Author: Daniel J. Brotman, MD, 600 North Wolfe Street, Meyer 8-134A, Baltimore, MD 21287; e-mail, [email protected]edu.This article was published at Annals.org on 14 December 2021. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoSafety and Efficiency of Diagnostic Strategies for Ruling Out Pulmonary Embolism in Clinically Relevant Patient Subgroups Milou A.M. Stals , Toshihiko Takada , Noémie Kraaijpoel , Nick van Es , Harry R. Büller , D. Mark Courtney , Yonathan Freund , Javier Galipienzo , Grégoire Le Gal , Waleed Ghanima , Menno V. Huisman , Jeffrey A. Kline , Karel G.M. Moons , Sameer Parpia , Arnaud Perrier , Marc Righini , Helia Robert-Ebadi , Pierre-Marie Roy , Maarten van Smeden , Phil S. Wells , Kerstin de Wit , Geert-Jan Geersing , and Frederikus A. Klok Metrics February 2022Volume 175, Issue 2Page: 295-296KeywordsD-dimerHospital medicinePulmonary embolismThrombosisVenous thromboembolism ePublished: 14 December 2021 Issue Published: February 2022 Copyright & PermissionsCopyright © 2021 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...