Markedly elevated plasma D-dimer and the prevalence of acute pulmonary embolus

Andrew W. Bowman, Gretchen S. Johns, Nolan Karstaedt


Objective. To evaluate if increasingly elevated levels of plasma Ddimerare associated with higher prevalence of acute pulmonaryembolus (PE). Patients and Methods. A retrospective study wasconducted evaluating all PE protocol CT examinations performed inlow-to-intermediate risk emergency department and hospitalized patientsduring 2007. All PE protocol CT reports were reviewed for thepresence or absence of acute PE. Th e charts of all of these subjectswere then reviewed for quantitative plasma D-dimer values, measuredin mg/ml Fibrinogen Equivalent Units, drawn within one day prior tothe CT exam. Th e prevalence of acute PE at diff erent D-dimer thresholdresults was then evaluated using D-dimer groups as follows: < 1.0mg/ml, ≥ 1.0 but < 2.0 mg/ml, ≥ 2.0 but < 4.0 mg/ml, and ≥ 4.0 mg/ml. Results. 943 PE protocol CT exams were reviewed. 410 subjectshad D-dimer values drawn before their CT exams; 30 (7.3%) of thesewere positive for acute PE. As D-dimer values became increasingly elevated,the prevalence of acute PE increased accordingly. In particular,D-dimer elevation ≥4.0 mg/ml was almost 94% specifi c for acute PEby CT criteria. Conclusion. Increased elevation of plasma D-dimer isassociated with increased prevalence of acute PE in low-to-intermediaterisk patients.


Pulmonary embolus; D-dimer; CT

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