Objective. To determine the utility of high quantitative D-dimer levels in the diagnosis of pulmonary embolism. Methods. D-dimer testing was performed in consecutive patients with suspected pulmonary embolism. We included patients with suspected pulmonary embolism with a high risk for venous thromboembolism, i.e. hospitalized patients, patients older than 80 years, with malignancy or previous surgery. Presence of pulmonary embolism was based on a diagnostic management strategy using a clinical decision rule (CDR), D-dimer testing and computed tomography. Results. A total of 1515 patients were included with an overall pulmonary embolism prevalence of 21%. The pulmonary embolism prevalence was strongly associated with the height of the D-dimer level, and increased fourfold with D-dimer levels greater than 4000 ng mL-1compared to levels between 500 and 1000 ng mL-1. Patients with D-dimer levels higher than 2000 ng mL-1and an unlikely CDR had a pulmonary embolism prevalence of 36%. This prevalence is comparable to the pulmonary embolism likely CDR group. When D-dimer levels were above 4000 ng mL-1, the observed pulmonary embolism prevalence was very high, independent of CDR score. Conclusion. Strongly elevated D-dimer levels substantially increase the likelihood of pulmonary embolism. Whether this should translate into more intensive diagnostic and therapeutic measures in patients with high D-dimer levels irrespective of CDR remains to be studied.

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doi.org/10.1111/j.1365-2796.2008.01972.x, hdl.handle.net/1765/29975
Journal of Internal Medicine
Erasmus MC: University Medical Center Rotterdam

Tick, L.W, Nijkeuter, M, Kramer, M.H.H, Hovens, M.M.C, Büller, H.R, Leebeek, F.W.G, & Huisman, M.V. (2008). High D-dimer levels increase the likelihood of pulmonary embolism. Journal of Internal Medicine, 264(2), 195–200. doi:10.1111/j.1365-2796.2008.01972.x