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Cited by 350Venous Thromboembolism Diagnosis and ManagementCardiovascular and Diving-Related ComplicationsBlood Coagulation and Thrombosis Mechanisms

The DOI matches its Crossref record; 45 of the 45 references it cites were found in a registry or an index.

Diagnosis of Pulmonary Embolism with d -Dimer Adjusted to Clinical Probability

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Kearon, Clive, de Wit, Kerstin, Parpia, Sameer, Schulman, Sam, Afilalo, Marc, Hirsch, Andrew, Spencer, Frederick A., Sharma, Sangita, D’Aragon, Frédérick, Deshaies, Jean-François, Le Gal, Gregoire, Lazo-Langner, Alejandro, Wu, Cynthia, Rudd-Scott, Lisa, Bates, Shannon M., Julian, Jim A.·2019·New England Journal of Medicine
DOI 10.1056/nejmoa1909159
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Abstract

BACKGROUND: Retrospective analyses suggest that pulmonary embolism is ruled out by a d-dimer level of less than 1000 ng per milliliter in patients with a low clinical pretest probability (C-PTP) and by a d-dimer level of less than 500 ng per milliliter in patients with a moderate C-PTP. METHODS: We performed a prospective study in which pulmonary embolism was considered to be ruled out without further testing in outpatients with a low C-PTP and a d-dimer level of less than 1000 ng per milliliter or with a moderate C-PTP and a d-dimer level of less than 500 ng per milliliter. All other patients underwent chest imaging (usually computed tomographic pulmonary angiography). If pulmonary embolism was not diagnosed, patients did not receive anticoagulant therapy. All patients were followed for 3 months to detect venous thromboembolism. RESULTS: A total of 2017 patients were enrolled and evaluated, of whom 7.4% had pulmonary embolism on initial diagnostic testing. Of the 1325 patients who had a low C-PTP (1285 patients) or moderate C-PTP (40 patients) and a negative d-dimer test (i.e., <1000 or <500 ng per milliliter, respectively), none had venous thromboembolism during follow-up (95% confidence interval [CI], 0.00 to 0.29%). These included 315 patients who had a low C-PTP and a d-dimer level of 500 to 999 ng per milliliter (95% CI, 0.00 to 1.20%). Of all 1863 patients who did not receive a diagnosis of pulmonary embolism initially and did not receive anticoagulant therapy, 1 patient (0.05%; 95% CI, 0.01 to 0.30) had venous thromboembolism. Our diagnostic strategy resulted in the use of chest imaging in 34.3% of patients, whereas a strategy in which pulmonary embolism is considered to be ruled out with a low C-PTP and a d-dimer level of less than 500 ng per milliliter would result in the use of chest imaging in 51.9% (difference, -17.6 percentage points; 95% CI, -19.2 to -15.9). CONCLUSIONS: A combination of a low C-PTP and a d-dimer level of less than 1000 ng per milliliter identified a group of patients at low risk for pulmonary embolism during follow-up. (Funded by the Canadian Institutes of Health Research and others; PEGeD ClinicalTrials.gov number, NCT02483442.).

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Crossref · 10.1056/nejmoa1909159

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Authors
Kearon, C., de Wit, K., Parpia, S., Schulman, S., Afilalo, M., Hirsch, A., Spencer, F. A., Sharma, S., D’Aragon, F., Deshaies, J.-F., Le Gal, G., Lazo-Langner, A., Wu, C., Rudd-Scott, L., Bates, S. M., & Julian, J. A.
Affiliations
  • Université de Sherbrooke (CA)
  • From the Departments of Medicine (C.K., K.W., S. Schulman, F.A.S., S. Sharma, S.M.B.), Health Research Methods, Evidence, and Impact (C.K., S.P., S. Schulman), and Oncology (S.P., L.R.-S., J.A.J.), McMaster University, Hamilton, ON, the Departments of Emergency Medicine (M.A.) and Medicine (A.H.), McGill University, Montreal, the Departments of Anesthesia (F.D.) and Family and Emergency Medicine (J.-F.D.), Sherbrooke University, Sherbrooke, QC, the Department of Medicine, University of Ottawa,...
ORCID
Venue
New England Journal of Medicine
Publisher
Massachusetts Medical Society
Published
2019-11-28
Volume
381
Issue
22
Pages
2125-2134
ISSN
  • 0028-4793 (ISSN-L)
  • 1533-4406
DOI
10.1056/nejmoa1909159
OpenAlex
W2990973273
Cited by
349
References
45
Citations by year
2026: 39 · 2025: 42 · 2024: 56 · 2023: 50 · 2022: 49 · 2021: 69 · 2020: 43 · 2019: 1
FWCI
31.02
Type
journal article
Language
en
Open access
Licence
www.nejmgroup.org/legal/terms-of-use.htm (vor)
Locations
  • New England Journal of Medicine (publishedVersion)
  • PubMed (publishedVersion)
Funders
Canadian Institutes of Health Research (MOP-130249)
Topics
  • Health Sciences › Medicine › Internal Medicine › Venous Thromboembolism Diagnosis and Management
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cardiovascular and Diving-Related Complications
  • Health Sciences › Medicine › Hematology › Blood Coagulation and Thrombosis Mechanisms
Keywords
pulmonary embolism, D-dimer, clinical probability, venous thromboembolism, diagnostic approach, CT pulmonary angiography, anticoagulation, outpatients, diagnostic cost reduction, diagnostic accuracy, sensitivity and specificity, negative predictive value, positive predictive value
MeSH terms
Computed Tomography Angiography, Clinical Decision Rules, Adult, Aged, Female, Fibrin Fibrinogen Degradation Products, Humans, Male, Middle Aged, Predictive Value of Tests, Probability, Prospective Studies, Pulmonary Embolism

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