<<The 2022 Lifelong Learning And Self-Assessment Study Guide, Table of Contents

Review 8: Diagnosis of Pulmonary Embolism With D-Dimer Adjusted to Clinical Probability

Reviewer

Rana Abualsaud, MD

New York Presbyterian Hospital Cornell/Columbia, Department of Emergency Medicine, Weill Cornell School of Medicine, New York, NY

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1. Article Citation
2. Synopsis
3. ABEM Quick Quiz
4. Discussion
5. Critique
6. Editor's Note
7. ABEM Quick Quiz Answers
8. Key Points
9. Table
   1. Table 1. Study Protocol
10. Original Article

Article Citation

Kearon C, de Wit K, Parpia S, et al. Diagnosis of pulmonary embolism with D-dimer adjusted to clinical probability. N Engl J Med. 2019;381(22):2125-2134.

Synopsis

This prospective study utilized D-dimer levels and clinical pretest probability (using the Wells criteria for pulmonary embolism) to determine the cutoffs and combinations that would identify the highest number of patients in whom pulmonary embolism (PE) could be ruled out, thus minimizing the chest imaging performed and the number of patients started on anticoagulant therapy. The study found that patients with a low clinical probability and a D-dimer <1000 ng/mL (standard level is <500 ng/mL) were at low risk for PE. Chest imaging was reduced when a D-dimer <1000 ng/mL was utilized versus the standard level of <500 ng/mL.

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