Am. J. Respir. Crit. Care Med.,
Volume 159, Number 5, May 1999, 1445-1449
D-Dimers in the Diagnosis of Pulmonary Embolism
DEBORAH A.
QUINN,
ROBERT B.
FOGEL,
CYNTHIA D.
SMITH,
MICHAEL
LAPOSATA,
B.
TAYLOR THOMPSON,
STEPHEN M.
JOHNSON,
ARTHUR C.
WALTMAN,
and
CHARLES A.
HALES
Pulmonary/Critical Care Unit, Department of Pathology, Division of Clinical Laboratories, and Vascular Radiology Division,
Massachusetts General Hospital, and Harvard Medical School, Boston, Massachusetts
The aim of this study was to determine if the absence of circulating D-dimers, as determined by latex
agglutination assays, can correctly exclude the presence of pulmonary embolism using pulmonary
angiography as the diagnostic endpoint. Blood samples were obtained prospectively at the time of
angiography for suspicion of acute pulmonary embolism. Plasma was assayed for D-dimer by five different latex agglutination assays. Angiographic evidence of pulmonary emboli was found in 34% (35/
103) of patients. The latex agglutination assays had sensitivities of 97 to 100% and specificities of 19 to 29%. The negative predictive value was 94 to 100%. However, a negative D-dimer was rare in patients with recent surgery, malignancy, or total bilirubin > 34 µmol/L (> 2 mg/dl). In 31 patients suspected of pulmonary emboli but without these confounding factors, the five D-dimer assays were
negative in 46 to 55% of patients with normal pulmonary angiograms. The negative predictive value
in these patients was 100% by all five latex agglutination assays tested. The latex agglutination assays for D-dimer, when the pulmonary angiogram is used as the diagnostic endpoint and in the absence of recent surgery, malignancy, or liver disease, appears to be a clinically useful test in the diagnosis of acute pulmonary embolism.
