Doubling the D-Dimer Threshold in Low-Risk Patients Still Allows Pulmonary Embolism to Be Safely Ruled Out

Applying a D-dimer threshold of 1000 ng/mL in patients with Wells scores ≤4 decreased imaging and resulted in no missed PE events.

Evidence supports adjusting D-dimer thresholds to rule out pulmonary embolism (PE) based on age or specific low-risk criteria (YEARS), but prospective evidence is lacking for elevated thresholds across broadly defined “low-risk” patients (NEJM JW Emerg Med Jul 2017 and Lancet 2017; 390:289; NEJM JW Womens Health May 2019 and N Engl J Med 2019; 380:1139). To determine the safety of doubling the D-dimer threshold to rule out PE in low-risk patients, researchers in Canada prospectively enrolled 2017 adults (66% female; mean age, 52 years) undergoing PE testing.

All patients were assessed with the Wells clinical prediction rule. PE was considered ruled out in patients with Wells scores ≤4 (low risk) if the D-dimer level was <1000 ng/mL, and in t…

Reviewing Author

Benton R. Hunter, MD

Disclosures

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Chair, Evidence Based Healthcare Interest Group)

Benton R. Hunter, MD

Disclosures

Leadership Positions in Professional SocietiesSociety for Academic Emergency Medicine (Chair, Evidence Based Healthcare Interest Group)

Doubling the D-Dimer Threshold in Low-Risk Patients Still Allows Pulmonary Embolism to Be Safely Ruled Out

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Reviewing Author