Quantitative D-dimer is a common screening tool to rule-out pulmonary embolism in low-risk population but is there more that it can tell us?


Yes, there have been studies linking increasing d-dimers to: 1) likelihood of PE, 2) location of PE, and 3) clot burden.

1. The level of d-dimer has been shown that with increasing d-dimer magnitude, there is an increasing chance of diagnosing pulmonary embolism by computed tomography with correlatory values as follows (as published by Kaush)[1]:

D-Dimer        % with PE

0.58-1.0        3.6%

1.0-2.0           8.0%

2.0-5.0          16.2%

5.0-20           35.3%

>20                 45.5%


2. There have also been some studies showing correlation between d-dimer magnitudes and location of clot, showing the higher the d-dimer, the more likely the PE is proximal/main (median >5.0) pulmonary artery vs. lobar vs. segmental [2].


3. Higher d-dimer values showing higher clot burden as calculated by CT clot burden scoring  for d-dimer values >4.0 (avg clot score 10 vs. 5) [3]. However, clot scoring varies in its predictive value of outcomes and is not a reliable predictor of patient mortality [4,5,6].


1.  Shah K, Quaas J, Rolston D, Bansal S, Bania T, Newman D, Wiener D, Lee J.
Magnitude of D-dimer matters for diagnosing pulmonary embolus. Am J Emerg Med.
2013 Jun;31(6):942-5.

2. Jeebun V, Doe SJ, Singh L, Worthy SA, Forrest IA. Are clinical parameters and
biomarkers predictive of severity of acute pulmonary emboli on CTPA? QJM. 2010

3. Hochuli M, Duewell S, Frauchiger B. Quantitative d-dimer levels and the extent
of venous thromboembolism in CT angiography and lower limb ultrasonography. Vasa.
2007 Nov;36(4):267-74

4. Subramaniam RM, Mandrekar J, Chang C, Blair D, Gilbert K, Peller PJ, Sleigh J,
Karalus N. Pulmonary embolism outcome: a prospective evaluation of CT pulmonary
angiographic clot burden score and ECG score. AJR Am J Roentgenol. 2008

5. Venkatesh SK, Wang SC. Central clot score at computed tomography as a
predictor of 30-day mortality after acute pulmonary embolism. Ann Acad Med
Singapore. 2010 Jun;39(6):442-7

6. Furlan A, Aghayev A, Chang CC, Patil A, Jeon KN, Park B, Fetzer DT, Saul M,
Roberts MS, Bae KT. Short-term mortality in acute pulmonary embolism: clot burden
and signs of right heart dysfunction at CT pulmonary angiography. Radiology. 2012

May 2024