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The Skeptics Guide to Emergency Medicine

SGEM#469: You Take My Breath Away – D-dimer for Ruling out PE in High-Risk Patients

Mar 1, 2025
In this discussion, Dr. Lauren Westafer, an Assistant Professor and pulmonary embolism expert from the University of Massachusetts Medical School, delves into the nuances of D-dimer testing. She highlights the challenges of ruling out pulmonary embolism (PE) in high-risk patients, spotlighting striking findings from recent research. The conversation critically assesses the reliability of D-dimer levels and biases in existing studies, urging a need for reevaluation of testing strategies for better outcomes in emergency medicine.
25:42

Episode guests

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Quick takeaways

  • D-dimer testing is a sensitive tool for excluding pulmonary embolism in low-risk patients but has limitations in high-risk cases.
  • Recent studies suggest exploring age-adjusted D-dimer thresholds, yet evidence is insufficient to alter guidelines on its routine use.

Deep dives

The Role of D-Dimer Testing in Pulmonary Embolism Diagnosis

D-dimer testing has emerged as a critical tool for the assessment of suspected pulmonary embolism (PE), especially in low and intermediate risk patients. It serves as a highly sensitive but not specific biomarker, allowing for the exclusion of PE without the need for further imaging when results are negative. Current guidelines suggest using a negative D-dimer result to rule out PE in these patients, reducing unnecessary exposure to imaging hazards. However, in high-risk patients, the utility of D-dimer is less clear, as its positive predictive value diminishes due to the variety of conditions that can cause elevated D-dimer levels.

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