Friday, December 20, 2019

Is it Safe to Adjust D-D ?

R.E.B.E.L.EM - December 16, 2019 - By Anand Swaminathan
..."Authors Conclusions:
“A combination of a low C-PTP and a d-dimer level of less than 1000 ng per milliliter identified a group of patients at low risk for pulmonary embolism during follow-up.”
Our Conclusions:
We agree with the authors. In a group of low pre-test probability patients for pulmonary embolism based on a Wells < 4, the D-dimer threshold can be safely set to 1000 ng/ml FEU (500 ng/ml DDU).
Potential to Impact Current Practice: 
Using the PEGeD approach, much like using YEARS or age-adjusted D-dimer approaches, can safely reduce the use of imaging in the evaluation of pulmonary embolism.
Bottom Line: 
The use of variable D-dimer thresholds based on clinical pre-test probability in the assessment of pulmonary embolism can reduce chest imaging and is ready for widespread ED use."