D-dimer

Differential Diagnosis

Factors that can cause false-negative D-dimer
- Symptoms of PE > 3 days
- Small PE
- Use of qualitative latex fixation test
- Use of anticoagulants
Factors that can cause false-positive D-dimer
- Cancer and malignancy
- Recent surgery
- Infection (eg, pneumonia, sepsis)
- Pregnancy
- Age > 70 years
- DIC
- Trauma
- Arterial thrombosis
- ACS/AMI
- Vaso-occlusive sickle cell crisis
- Acute CVA
- Vasculitis
- Superficial phlebitis

Traditional cutoff value = 500
Age-adjusted (for over 50 years old) = age x 10
- Maintains high sensitivity while increasing specificity[1]
YEARS[2] and PEGeD[3] adjust cut off base on clinical probability still being studied.

Sharp AL, et al. An Age-Adjusted D-dimer Threshold for Emergency Department Patients with Suspected Pulmonary Embolus: Accuracy and Clinical Implications. Feb 2016. Annals of EM. 67(2);249-257.
MDCalc YEARS https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe
Anand Swaminathan, "PEGeD Study – Is It Safe to Adjust the D-Dimer Threshold for Clinical Probability?", REBEL EM blog, December 16, 2019. Available at: https://rebelem.com/peged-study-is-it-safe-to-adjust-the-d-dimer-threshold-for-clinical-probability/

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