D-dimer can help differentiate suspected pulmonary embolism patients that require anti-coagulation

Objectives: Determine whether D-dimer concentration in the absence of imaging can differentiate patients that require anti-coagulation from patients who do not require anti-coagulation. Methods: Data was obtained retrospectively from 366 hemodynamically stable adult ED patients with suspected pulmonary embolism (PE). Patientswere categorized by largest occluded artery and aggregated into: 'Require anti-coagulation' (main, lobar, and segmental PE), 'Does not require anti-coagulation' (sub-segmental and No PE), 'High risk of deterioration' (main and lobar PE), and 'Not high risk of deterioration' (segmental, sub-segmental, and No PE) groups. Wilcoxon rank-sum test was used for 2 sample comparisons of median D-dimer concentrations. Receiver operating characteristic (ROC) curve analysiswas utilized to determine a D-dimer cut-off that could differentiate 'Require anti-coagulation' from 'Does not require anti-coagulation' and 'High risk of deterioration' from 'Low risk of deterioration' groups. Results: The 'Require anti-coagulation' group had a maximum area under the curve (AUC) of 0.92 at an ageadjusted D-dimer cut-off of 1540 with a specificity of 86% (95% CI, 81-91%), and sensitivity of 84% (79-90%). The 'High risk of deterioration' group had a maximum AUC of 0.93 at an age-adjusted D-dimer cut-off of 2500 with a specificity of 90% (85-93%) and sensitivity of 83% (77-90%). Conclusions: An age-adjusted D-dimer cut-off of 1540 ng/mL differentiates suspected PE patients requiring anticoagulation fromthose not requiring anti-coagulation. A cut-off of 2500 differentiates those with high risk of clinical deterioration fromthose not at high risk of deterioration. When correlatedwith clinical outcomes, these cutoffs can provide an objective method for clinical decision making when imaging is unavailable. (C) 2020 Published by Elsevier Inc.

Automated summary

This study aimed to determine whether D-dimer concentration can differentiate patients that require anti-coagulation from those who do not in the absence of imaging. Results showed that age-adjusted D-dimer cut-offs were effective in distinguishing these two groups of patients.