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In Reply: We disagree with Drs Takagi and Umemoto regarding their statement that other management studies indicate that patients classified as PE unlikely but with an abnormal D-dimer test ought to be treated with anticoagulant therapy.^1-4 These studies demonstrate that in patients with a low probability of PE combined with a normal D-dimer test it is safe to exclude PE. However, in all other patients, including those with a low probability of PE and an abnormal D-dimer test, further objective testing is warranted to exclude or diagnose PE.

Wells et al¹ suggested that it is safe to use 2 instead of 3 categories of pretest probability and to exclude PE in patients classified as PE unlikely combined with a normal D-dimer test, with the benefit of avoiding diagnostic tests in a larger percentage of patients. Our results prospectively validated this post hoc observation and showed that it is safe to . . . [Full Text of this Article]

Mathilde Nijkeuter, MD
Department of General Internal Medicine/Endocrinology
Leiden University Medical Center
Leiden, the Netherlands

M. H. Prins, MD
Department of Clinical Epidemiology
University Hospital
Maastricht, the Netherlands

H. R. Büller, MD, PhD
Department of Vascular Medicine
Academic Medical Center
Amsterdam, the Netherlands

Menno V. Huisman, MD
m.v.huisman@lumc.nl
Department of General Internal Medicine/Endocrinology
Leiden University Medical Center
Leiden, the Netherlands

for the Christopher Study Investigators

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