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[Does D-dimer determination allow the exclusion of pulmonary embolism?]
1Division d'Angiologie et d'Hémostase, Hôpitaux Universitaires de Genève, Suisse.
Revue De Pneumologie Clinique
|October 14, 1998
Summary
D-dimer testing can effectively rule out pulmonary embolism in ambulatory patients. A low D-dimer level, below 500 micrograms/l, indicates no embolism, reducing unnecessary diagnostic tests and costs.
Area of Science:
- Biochemistry
- Medical Diagnostics
Context:
- Pulmonary embolism (PE) diagnosis often requires extensive testing.
- D-dimer levels reflect fibrinolysis, a marker of clot formation and breakdown.
Purpose:
- To evaluate the utility of D-dimer assay as a screening tool for pulmonary embolism.
- To determine the clinical and economic benefits of D-dimer testing in specific patient populations.
Summary:
- A serum D-dimer level below 500 micrograms/l effectively excludes pulmonary embolism with 95% predictive value in ambulatory patients.
- ELISA tests are validated for routine practice; latex tests lack sufficient sensitivity.
- D-dimer assay has low specificity in hospitalized patients (over 24 hours) not suspected of PE, limiting its benefit.
Impact:
- Enables cost reduction by avoiding further investigations in approximately one-third of suspected PE cases.
- Streamlines diagnostic pathways for ambulatory patients with suspected pulmonary embolism.
- Highlights the importance of selecting appropriate diagnostic assays (ELISA) and patient populations for D-dimer testing.