Normal D-Dimer Levels in Patients With Pulmonary Embolism

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Abstract
PULMONARY EMBOLISM (PE) is a well-recognized event in acute care because of its frequency, various clinical presentations, and potential morbidity and mortality. The annual incidence is 69 per 100,000.1 Untreated patients with PE have mortality rates as high as 30%.2 It is difficult to accurately and cost-effectively diagnose PE. We use ventilation-perfusion (V/Q) scans in addition to clinical suspicion to diagnose and then decide whether to treat patients with anticoagulation therapy. However, this is useful for only half of the patients with suspected PE.3 Ventilation-perfusion scans are not interpreted as normal or abnormal but rather across a spectrum as normal, low probability, intermediate or indeterminate probability, and high probability. Consequently, patients may undergo pulmonary angiograms (PAGs), the standard criterion, to confirm the diagnosis. Unfortunately, PAGs are not always readily accessible, are cumbersome, are expensive, and have documented rates of morbidity (5%) and mortality (0.5%).4 Helical computed tomographic scans hold some promise, but are not the standard of care.