• Am J Emerg Med · Jun 2013

    Case Reports

    Decreasing D-dimer after recent negative computed tomographic pulmonary angiogram does not rule out pulmonary embolism.

    • Bruce M Lo.
    • Eastern Virginia Medical School, Sentara Norfolk General Hospital, Department of Emergency Medicine, Norfolk, VA 23507, USA. brucelo1@yahoo.com
    • Am J Emerg Med. 2013 Jun 1;31(6):996.e5-6.

    AbstractAn algorithmic approach to testing utilizing risk stratification and quantitative D-dimer has been considered an acceptable approach to ruling out pulmonary embolism (PE). When D-dimer is elevated, further testing for PE is indicated. However, no evidence exists to guide practitioners when patients return after a recent negative workup for PE who previously had an elevated D-dimer. This case describes a patient who initially had an elevated D-dimer with negative workup for PE who, on repeat visit, had a decreasing D-dimer but was diagnosed with a PE. When evaluating patients after a negative workup for PE after an elevated D-dimer, a decrease in D-dimer cannot be used to rule out PE.

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