D-dimer: Difference between revisions
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**Small [[PE]] | **Small [[PE]] | ||
**Use of qualitative latex fixation test | **Use of qualitative latex fixation test | ||
**Use of anticoagulants | **Use of [[anticoagulants]] | ||
*'''Factors that can cause false-positive D-dimer''' | *'''Factors that can cause false-positive D-dimer''' | ||
**Cancer and malignancy | **Cancer and malignancy | ||
| Line 13: | Line 13: | ||
**Age > 70 years | **Age > 70 years | ||
**[[DIC]] | **[[DIC]] | ||
**Trauma | **[[Trauma]] | ||
**Arterial thrombosis | **[[Arterial thrombosis]] | ||
**[[ACS]]/AMI | **[[ACS]]/AMI | ||
**Vaso-occlusive [[sickle cell crisis]] | **Vaso-occlusive [[sickle cell crisis]] | ||
**Acute [[CVA]] | **Acute [[CVA]] | ||
**Vasculitis | **[[Vasculitis]] | ||
**Superficial [[phlebitis]] | **Superficial [[phlebitis]] | ||
==Evaluation== | ==Evaluation== | ||
*Traditional cutoff value = 500 | *Traditional cutoff value = 500 | ||
*Age-adjusted (for | *Age-adjusted (for patients 50 years or older) = age x 10 | ||
**D-dimer less than OR equal to age x 10 makes VTE unlikely | |||
**Maintains high sensitivity while increasing specificity<ref>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.</ref> | **Maintains high sensitivity while increasing specificity<ref>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.</ref> | ||
*YEARS<ref>MDCalc YEARS https://www.mdcalc.com/years-algorithm-pulmonary-embolism-pe</ref> and PEGeD<ref>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/</ref> adjust cut off base on clinical probability still being studied. | |||
==See Also== | ==See Also== | ||
*[[Age adjusted D-dimer]] | |||
*[[Pulmonary embolism]] | *[[Pulmonary embolism]] | ||
*[[Deep venous thrombosis]] | *[[Deep venous thrombosis]] | ||
*[[ | *[[Pulmonary_embolism_in_pregnancy#D-Dimer|D-dimer for pulmonary embolism in pregnancy]] | ||
==External Links== | ==External Links== | ||
Latest revision as of 17:24, 25 March 2021
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
Evaluation
- Traditional cutoff value = 500
- Age-adjusted (for patients 50 years or older) = age x 10
- D-dimer less than OR equal to age x 10 makes VTE unlikely
- Maintains high sensitivity while increasing specificity[1]
- YEARS[2] and PEGeD[3] adjust cut off base on clinical probability still being studied.
See Also
- Age adjusted D-dimer
- Pulmonary embolism
- Deep venous thrombosis
- D-dimer for pulmonary embolism in pregnancy
External Links
- D-dimer threshold increase. Kline et. al.
- Pediatric Emergency Playbook Podcast: Big Labs, Little People
References
- ↑ 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/