Appropriateness of Excluding Pulmonary Embolism

Letters18 July 2006Appropriateness of Excluding Pulmonary EmbolismPierre-Marie Roy, MD, PhD and Guy Meyer, MDPierre-Marie Roy, MD, PhDFrom University Hospital of Angers, 49033 Angers Cedex 01, France.Search for more papers by this author and Guy Meyer, MDFrom University Hospital of Angers, 49033 Angers Cedex 01, France.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-145-2-200607180-00019 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail IN RESPONSE: We indeed considered the exclusion of PE on the basis of a negative ELISA d-dimer result appropriate even in patients with a high pretest probability; doing so was part of the recommendations of the European Society of Cardiology (1). We acknowledge that this criterion for excluding PE is debatable from an evidence-based medicine point of view (2). It has been evaluated in large outcomes studies (3, 4), but only a few patients had the combination of a high pretest probability and a negative result on an ELISA d-dimer test (5). As a general rule, we considered as appropriate ...References1. Guidelines on diagnosis and management of acute pulmonary embolism. Task Force on Pulmonary Embolism, European Society of Cardiology. Eur Heart J. 2000;21:1301-36. [PMID: 10952823] CrossrefMedlineGoogle Scholar2. Roy PM, Colombet I, Durieux P, Chatellier G, Sors H, Meyer G. Systematic review and meta-analysis of strategies for the diagnosis of suspected pulmonary embolism. BMJ. 2005;331:259. [PMID: 16052017] CrossrefMedlineGoogle Scholar3. Perrier A, Desmarais S, Miron MJ, de Moerloose P, Lepage R, Slosman D, et al. Non-invasive diagnosis of venous thromboembolism in outpatients. Lancet. 1999;353:190-5. [PMID: 9923874] CrossrefMedlineGoogle Scholar4. Perrier A, Roy PM, Aujesky D, Chagnon I, Howarth N, Gourdier AL, et al. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multicenter management study. Am J Med. 2004;116:291-9. [PMID: 14984813] CrossrefMedlineGoogle Scholar5. Righini M, Aujesky D, Roy PM, Cornuz J, de Moerloose P, Bounameaux H, et al. Clinical usefulness of D-dimer depending on clinical probability and cutoff value in outpatients with suspected pulmonary embolism. Arch Intern Med. 2004;164:2483-7. [PMID: 15596640] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University Hospital of Angers, 49033 Angers Cedex 01, France.Disclosures: None disclosed. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoAppropriateness of Diagnostic Management and Outcomes of Suspected Pulmonary Embolism Pierre-Marie Roy , Guy Meyer , Bruno Vielle , Catherine Le Gall , Franck Verschuren , Françoise Carpentier , Philippe Leveau , Alain Furber , and Appropriateness of Excluding Pulmonary Embolism Herman M.A. Hofstee Metrics Cited ByPathobiology of pulmonary arterial hypertension: understanding the roads less travelledNovel Therapeutic Strategies for Reducing Right Heart Failure Associated Mortality in Fibrotic Lung DiseasesCurrent and Emerging Therapies for Pulmonary Arterial HypertensionInterleukin-6 as a Potential Therapeutic Target for Pulmonary Arterial HypertensionD-Dimer Level and the Risk for Thrombosis in Systemic Lupus Erythematosus 18 July 2006Volume 145, Issue 2Page: 152KeywordsConflicts of interestEnzyme linked immunosorbent assayEvidence based medicinePulmonary embolism ePublished: 18 July 2006 Issue Published: 18 July 2006 CopyrightCopyright © 2006 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...