Ruling out clinically suspected pulmonary embolism by assessment of clinical probability and D-dimer levels: a management study

Monique G. L. Leclercq; Johan G. Lutisan; Marinus van Marwijk Kooy; Bart F. Kuipers; Ad H. J. Oostdijk; Jef J. C. M. van der Leur; Harry R. Büller

doi:10.1055/s-0037-1613548

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2003; 89(01): 97-103
DOI: 10.1055/s-0037-1613548

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Ruling out clinically suspected pulmonary embolism by assessment of clinical probability and D-dimer levels: a management study

Monique G. L. Leclercq

¹Department of Internal Medicine, Isala clinics, location Sophia, Zwolle

,

Johan G. Lutisan

¹Department of Internal Medicine, Isala clinics, location Sophia, Zwolle

,

Marinus van Marwijk Kooy

¹Department of Internal Medicine, Isala clinics, location Sophia, Zwolle

,

Bart F. Kuipers

²Department of Pulmonology, Isala clinics, location Sophia, Zwolle

,

Ad H. J. Oostdijk

³Department of Nuclear Medicine, Isala clinics, location Sophia, Zwolle

,

Jef J. C. M. van der Leur

⁴Department of Clinical Chemistry, Isala clinics, location Sophia, Zwolle

,

Harry R. Büller

¹Department of Internal Medicine, Isala clinics, location Sophia, Zwolle

› Author Affiliations

Abstract

Summary

D-dimer test combined with clinical probability assessment has been proposed as the first step in the diagnostic work-up of patients with suspected pulmonary embolism (PE). In a prospective management study we investigated the safety and efficiency of excluding PE by a normal D-dimer combined with a low or moderate clinical probability. Of the 202 study patients this combination ruled out PE in 64 (32%) patients. The 3-month thromboembolic risk in these patients was 0% (95% CI, 0.0-5.6%).The prevalence of PE in the entire cohort was 29% (59 patients), whereas in the low, moderate and high clinical probability groups this was 25%, 26% and 50%, respectively. We conclude that ruling out suspected PE by a normal D-dimer combined with a low or moderate clinical probability appears to be a safe and efficient strategy. The accuracy of the clinical probability assessment is modest.

Keywords

Pulmonary embolism - management - diagnosis - D-dimer - clinical probability

Full Text

References

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