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Samuel Z. Goldhaber, MD; Grant R. Simons, MD; C. Gregory Elliott, MD; William D. Haire, MD; Robert Toltzis, MD; Stephen C. Blacklow, MD, PhD; Marc H. Doolittle, MD; David S. Weinberg, MD, PhD

JAMA. 1993;270(23):2819-2822.

Abstract
Objective.
—To test the hypothesis that a low D-dimer level has a high negative predictive value for acute pulmonary embolism (PE) among patients undergoing diagnostic pulmonary angiography.

Design.
—Blinded comparison of quantitative plasma D-dimer levels, measured using a monoclonal antibody assay, with pulmonary angiographic results from 173 patients with suspected acute PE.

Setting.
—Tertiary care setting at four participating institutions.

Patients.
—Plasma samples were analyzed in 173 patients who underwent diagnostic pulmonary arteriography for suspected acute PE.

Main Outcome Measures.
—Sensitivity, specificity, and predictive values of quantitative plasma D-dimer levels for the diagnosis of PE, using pulmonary angiographic data as the criterion standard test.

Results.
—Of 35 patients with D-dimer values less than 500 ng/mL, only three had abnormal pulmonary angiograms. The negative predictive value of a plasma D-dimer level less than 500 ng/mL for acute PE was 91.4% (95% confidence interval [CI], 76.9% to 98.2%). D-dimer levels were greater than 500 ng/mL in 42 of 45 patients with PE and in 96 of 128 patients without PE (P=.016). Sensitivity, specificity, and positive predictive value of a plasma D-dimer level greater than 500 ng/mL for acute PE were 93.3% (95% CI, 81.7% to 98.6%), 25.0% (95% CI,17.5% to 32.5%), and 30.4% (95% CI, 22.8% to 38.1%), respectively.

Conclusions.
—The results of our study indicate that quantitative plasma D-dimer levels can be useful in screening patients with suspected PE who require pulmonary angiography. Plasma D-dimer values less than 500 ng/mL may obviate the need for pulmonary angiography, particularly among medical patients for whom the clinical suspicion of PE is low. The plasma D-dimer value, assayed using a commercially available enzyme-linked immunosorbent assay kit, is a sensitive but nonspecific test for the presence of acute PE.

JAMA. 1993;270:2819-2822)

Author Affiliations
From the Departments of Medicine (Drs Goldhaber and Simons) and Pathology (Drs Blacklow, Doolittle, and Weinberg), Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Pulmonary Division, LDS Hospital, Salt Lake City, Utah (Dr Elliott); the University of Nebraska Medical Center, Omaha (Dr Haire); and Christ Hospital, Cincinnati, Ohio (Dr Toltzis). Dr Simons is now with the Division of Cardiology, Department of Medicine, Duke University Medical Center, Durham, NC.

Footnotes
Reprint requests to the Cardiovascular Division, Brigham and Women's Hospital, 75 Francis St, Boston, MA 02115 (Dr Goldhaber).

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