The Skeptics Guide to Emergency Medicine

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

6 snips
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.
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INSIGHT

PE Diagnosis Challenge

  • Pulmonary Embolism (PE) is life-threatening and requires careful consideration.
  • Doctors must balance the risk of missing a PE against the harms of unnecessary imaging.
INSIGHT

D-dimer Test Utility

  • D-dimer tests help assess PE risk, especially for low-to-moderate-risk patients.
  • It has a high negative predictive value, ruling out PE without further imaging.
INSIGHT

D-dimer in High-Risk Patients

  • D-dimer's utility is less clear in high-risk PE patients due to many factors that elevate it.
  • Traditional methods often skip D-dimer and go straight to CTPA for these patients.
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