[Importance of biomarkers in pulmonary embolism]

Pulmonary embolism (PE) is the third most prevalent cardiovascular disease and a major cause for hospitalization, morbidity and mortality in western industrialized countries. The patients' clinical presentation varies greatly with often unspecific symptoms. These circumstances render a quick diagnosis and treatment initiation important but both remain clinical challenges. The D‑dimers become detectable after activation of the coagulation system with production and subsequent degradation of fibrin. They currently represent the only general biomarker that reflects the activity of the coagulation cascade. This review describes the role of D‑dimers in the diagnostics of PE as well as important points to be considered and the limits of this biomarker. In conclusion, D‑dimers are a reliable biomarker for excluding PE if used in combination with the clinical pretest probability. Test-specific thresholds must be used. In patients aged 50 years or above, age-adjusted cut-offs should be used. The use of D‑dimers is not recommended in patients with certain diseases or in situations that are accompanied by increased D‑dimers without the presence of PE. Such situations include malignancies, major surgery, infections and pregnancy.