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Clinical probability-adjusted (CPA) D-dimer thresholds for the exclusion of venous thromboembolism (VTE) in the emergency department
  1. Erin Devlin1,
  2. Daniel Horner2
  1. 1Emergency Department, Mater Misericordiae University Hospital, Dublin, Ireland
  2. 2Critical Care Department, Northern Care Alliance NHS Foundation Trust, Salford, UK
  1. Correspondence to Erin Devlin; erindevlin{at}mater.ie

Abstract

A short review of the literature was carried out to examine the evidence supporting the use of clinical probability-adjusted (CPA) D-dimer thresholds to exclude venous thromboembolic (VTE) disease in an ED setting. Five papers were identified as suitable for inclusion using the reported search strategy. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the best papers are tabulated. It is concluded that using CPA D-dimer thresholds to exclude VTE without recourse to imaging will improve the efficiency of the test, but may increase the failure rate to unacceptable levels. CPA thresholds should be used with caution on an individual basis, supported by shared decision-making.

  • thrombo-embolic disease
  • diagnosis
  • management
  • pulmonary embolism
  • diagnostic tests

https://doi.org/10.1136/emermed-2025-215028

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    Footnotes

    • Handling editor Richard Body

    • X @Exrcemprof

    • Contributors ED completed the report. DH checked the report. DH is the guarantor.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Disclaimer Best Evidence Topic reports (BETs) summarise the evidence pertaining to particular clinical questions. They are not systematic reviews, but rather contain the best (highest level) evidence that can be practically obtained by busy practising clinicians. The search strategies used to find the best evidence are reported in detail in order to allow clinicians to update searches whenever necessary. Each BET is based on a clinical scenario and ends with a clinical bottom line which indicates, in the light of the evidence found, what the reporting clinician would do if faced with the same scenario again. This BET was first published on the BestBETs website at http://www.bestbets.org and has been reproduced with permission.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; internally peer reviewed.