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

Full Text:



Remy-Jardin M, Remy J, Deschildre F, Artaud D, Beregi JP, Hossein-Foucher C, et al. Diagnosis of pulmonary embolism with spiral CT: comparison with pulmonary angiography and scintigraphy. Radiology. 1996;200:699-706.

Wells PS, Ginsberg JS, Anderson DR, Kearon C, Gent M, Turpie AG, et al. Use of a clinical model for safe management of patients with suspected pulmonary embolism. Ann Intern Med. 1998;129:997-1005.

Wells PS, Anderson DR, Rodger M, Ginsberg JS, Kearon C, Gent M, et al. Derivation of a simple clinical model to categorize patients probability of pulmonary embolism: increasing the models utility with the SimpliRED D-dimer. Th romb Haemost. 2000;83:416-20.

Stein PD, Hull RD, Patel KC, Olson RE, Ghali WA, Brant R, et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med. 2004;140:589-602.

Gupta RT, Kakarla RK, Kirshenbaum KJ, Tapson VF. D-dimers and effi cacy of clinical risk estimation algorithms: sensitivity in evaluation of acute pulmonary embolism. AJR Am J Roentgenol. 2009;193:425-30.

Corwin MT, Donohoo JH, Partridge R, Egglin TK, Mayo-Smith WW. Do emergency physicians use serum D-dimer eff ectively to determine the need for CT when evaluating patients for pulmonary embolism? Review of 5,344 consecutive patients.

AJR Am J Roentgenol. 2009;192:1319-23.

Hirai LK, Takahashi JM, Yoon HC. A prospective evaluation of a quantitative D-dimer assay in the evaluation of acute pulmonary embolism. J Vasc Interv Radiol. 2007;18:970-4.

Gimber LH, Travis RI, Takahashi JM, Goodman TL, Yoon HC. Computed Tomography Angiography in Patients Evaluated for Acute Pulmonary Embolism with Low Serum D-dimer Levels: A

Prospective Study. Perm J. 2009;13:4-10.

Sanchez LD, McGillicuddy DC, Volz KA, Fan SL, Joyce N, Horowitz GL. Eff ect of two diff erent FDA-approved D-dimer assays on resource utilization in the emergency department. Acad Emerg Med. 2011;18(3):317-21.

Weiss CR, Haponik EF, Diette GB, Merriman B, Scatarige JC, Fishman EK. Pretest risk assessment in suspected acute pulmonary embolism. Acad Radiol. 2008;15:3-14.

Eng J, Krishnan JA, Segal JB, Bolger DT, Tamariz LJ, Streiff MB, et al. Accuracy of CT in the diagnosis of pulmonary embolism: a systemic literature review. AJR Am J Roentgenol. 2004;183:1819-27.


  • There are currently no refbacks.

2019 Department of Medical Sciences, Academy of Sciences and Arts of Bosnia and Herzegovina, Sarajevo, Bosnia and Herzegovina. All rights reserved.
The full text of articles published in this journal can be used free of charge for personal and educational purposes while respecting authors and publishers’ copyrights. For commercial purposes no part of this journal may be reproduced without the written permission of the publisher.