Fibrin D-dimer measurement in suspected pulmonary embolism

Due to increased awareness among physicians, the prevalence of pulmonary embolism (PE) in patients clinically suspected of the disease has steadily decreased during the past 15 years. This has led to the development of simple diagnostic tools in an attempt to reduce the number of invasive or costly exams needed to manage these patients. D-dimer (DD) measurement has proven to be a simple and very useful test to exclude PE and several strategies combining DD with clinical probability and other exams have been validated in large outcome studies. The problem faced by many physicians is the choice of the specific DD test and its more appropriate position in the diagnostic work-up of patients suspected of PE. This article focuses on these questions and also provides some limitations of DD use, such as its poor specificity in hospitalized and elderly patients.