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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Monday, April 6, 2020

Flex your D Dimer

Taming The SRU - By Comisky A  - April 06, 2020
"Few diagnostic tests draw the ire that D dimer does. From ubiquitous to demonic, for most of this test’s existence it has been a dichotomous marker of clot, either a positive led to diagnostic testing and a negative was a clean pass. In this post, we will walk through why we should broaden our view of D dimer and adapt it to a variety of patients to properly risk stratify them.
When comparing the various D dimer adjuncts, they all have their intended uses and targeted populations. The PEGeD study is the newest of the adjuncts but seems promising with its overall reductions in imaging and promising three month follow results. However, when comparing convenience and practicality, the YEARS criteria only asks for the clinician to remember three measures in order to properly use the algorithm, with an added reduction in imaging compared to the standard. Pregnancy-adjusted YEARS does ask for an additional step with the tradeoff of less imaging/radiation exposure to the gravid uterus. With the age-adjusted D dimer, there was also an apparent reduction in imaging and CIN compared to the standard Wells score, even with the reduction in sensitivity. So when asking which is the better algorithm to use, the answer is dependent on which population the clinician is applying it to."