Rational use of D-dimer measurement to exclude acute venous thromboembolic disease.

Clinical diagnosis of venous thromboembolic (VTE) disease is often inaccurate because signs and symptoms are nonspecific. Testing for the absence of D-dimer levels in the blood of patients with suspected deep venous thrombosis and pulmonary embolism can assist in ruling out these illnesses. Some highly sensitive D-dimer assays have sufficient specificity to assist in the exclusion of VTE disease. Numerous clinical management trials using D-dimer measurement in association with additional diagnostic tests have shown that it is safe to withhold anticoagulant therapy in selected patients with suspected VTE disease who have negative D-dimer assay results. Applying these diagnostic strategies can potentially decrease the need for radiological testing. The simplicity of measuring D-dimer levels creates the potential for misuse. For safe patient management, clinicians must understand the indications for and limitations of D-dimer measurement in the diagnosis of VTE disease.