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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
1   Department of Internal Medicine, Isala clinics, location Sophia, Zwolle
,
Johan G. Lutisan
1   Department of Internal Medicine, Isala clinics, location Sophia, Zwolle
,
Marinus van Marwijk Kooy
1   Department of Internal Medicine, Isala clinics, location Sophia, Zwolle
,
Bart F. Kuipers
2   Department of Pulmonology, Isala clinics, location Sophia, Zwolle
,
Ad H. J. Oostdijk
3   Department of Nuclear Medicine, Isala clinics, location Sophia, Zwolle
,
Jef J. C. M. van der Leur
4   Department of Clinical Chemistry, Isala clinics, location Sophia, Zwolle
,
Harry R. Büller
1   Department of Internal Medicine, Isala clinics, location Sophia, Zwolle
› Author Affiliations
Further Information

Publication History

Received 22 August 2002

Accepted after revision 17 October 2002

Publication Date:
09 December 2017 (online)

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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
 

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