NYU Langone Health Med-Lit Review
Clinical Question: Can d-dimers rule out pulmonary embolisms when not “within normal limits?”
Background: D-dimer tests are frequently ordered at low clinical thresholds, but values not “within normal limits” are often considered insufficient for ruling out pulmonary embolisms.
Study Design: Prospective multicenter cohort study
Setting: 12 hospitals in the Netherlands
Synopsis: The YEARS algorithm for ruling out pulmonary embolisms was applied for 3,465 patients with suspected acute pulmonary embolism between Oct 2013 and July 2015. After consideration of three findings derived from Wells’ criteria for pulmonary embolism, pulmonary embolisms were ruled out by d-dimer threshold values of 500 ng/mL versus 1,000 ng/mL. Of the 2,946 (85%) patients for whom the YEARS algorithm ruled out pulmonary embolism, 18 patients (incidence 0.61%; 95% CI, 0.36 to 0.96) were diagnosed with symptomatic venous thromboembolism at three-month follow-up.
Bottom Line: The altered d-dimer cutoffs of YEARS algorithm provide a useful method for ruling out pulmonary embolisms.
Citation: van der Hulle T, et al. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet. 2017;390(10091):289-297. doi: 10.1016/S0140-6736(17)30885-1.
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Dr. Shih is a hospitalist at the Manhattan campus of the VA New York Harbor Healthcare System in New York and a clinical assistant professor with the department of medicine at NYU Grossman Long Island School of Medicine in Mineola, New York.