D-dimer
Differential Diagnosis
- Factors that can cause false-negative D-dimer
- Symptoms of PE > 3 days
- Small PE
- Use of qualitative latex fixation test
- Use of anticoagulants
- Factors that can cause false-positive D-dimer
- Cancer and malignancy
- Recent surgery
- Infection (eg, pneumonia, sepsis)
- Pregnancy
- Age > 70 years
- DIC
- Trauma
- Arterial thrombosis
- ACS/AMI
- Vaso-occlusive sickle cell crisis
- Acute CVA
- Vasculitis
- Superficial phlebitis
Evaluation
- Traditional cutoff value = 500
- Age-adjusted (for patients 50 years or older) = age x 10
- D-dimer less than OR equal to age x 10 makes VTE unlikely
- Maintains high sensitivity while increasing specificity[1]
- YEARS[2] and PEGeD[3] adjust cut off base on clinical probability still being studied.
See Also
- Age adjusted D-dimer
- Pulmonary embolism
- Deep venous thrombosis
- D-dimer for pulmonary embolism in pregnancy
External Links
- D-dimer threshold increase. Kline et. al.
- Pediatric Emergency Playbook Podcast: Big Labs, Little People
References
- ↑ Sharp AL, et al. An Age-Adjusted D-dimer Threshold for Emergency Department Patients with Suspected Pulmonary Embolus: Accuracy and Clinical Implications. Feb 2016. Annals of EM. 67(2);249-257.
- ↑ MDCalc YEARS https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe
- ↑ Anand Swaminathan, "PEGeD Study – Is It Safe to Adjust the D-Dimer Threshold for Clinical Probability?", REBEL EM blog, December 16, 2019. Available at: https://rebelem.com/peged-study-is-it-safe-to-adjust-the-d-dimer-threshold-for-clinical-probability/