Meta-analysis finds low failure rates for adaptive D-dimer PE strategies

This systematic review and meta-analysis pooled six prospective diagnostic management studies (12,194 patients) evaluating adaptive, age- or clinical probability-adjusted D-dimer thresholds used to guide chest imaging in suspected pulmonary embolism. The pooled diagnostic failure rate (venous thromboembolism or PE-related/unexplained death within 3 months) was 0.12% overall among patients in whom PE was ruled out without CTPA, and 0.50% specifically among patients with D-dimer levels above the fixed 500 ng/mL threshold but below the adaptive threshold (the 'adaptive window'). The authors state that the diagnostic failure rate of adaptive strategies is acceptably low, including in the adaptive window subgroup.

Most relevant for: Patients being evaluated for suspected pulmonary embolism using adaptive D-dimer diagnostic strategies, including those with D-dimer levels falling in the adaptive window between fixed and age/clinical probability-adjusted thresholds.

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