D-dimer levels for the exclusion of pulmonary embolism: Making sense of international guideline recommendations

Bingwen Eugene Fan, Giuseppe Lippi, Emmanuel J Favaloro

Research output: Contribution to journalReview articlepeer-review

2 Citations (Scopus)

Abstract

Several international guidelines provide recommendations around the use of D-dimer testing for exclusion of pulmonary embolism, including the appropriate D-dimer threshold (or cutoff), but there is no consensus among them. We briefly discuss guideline variation, performance characteristics, and limitations of commercially available D-dimer assays in this setting, referencing the Clinical and Laboratory Standards Institute guidelines that recommend immunoassays with high sensitivity (≥97%) and negative predictive value (≥98%). While age-adjusted D-dimer and pretest-adjusted D-dimer are considered a safe strategy across predefined patient subgroups, clinicians need to recognize the different performance characteristics of D-dimer assays to enable safe clinical decisions for their patients. Importantly, D-dimer values must be correlated not only to clinical findings but also interpreted within the context of the accuracy and precision of the specific testing modality, adhering to manufacturer specifications that are approved by regulatory authorities.

Original languageEnglish
Pages (from-to)604-608
Number of pages5
JournalJournal of Thrombosis and Haemostasis
Volume22
Issue number3
Early online date20 Dec 2023
DOIs
Publication statusPublished - Mar 2024

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