When can pulmonary embolism (PE) be reliably excluded?

Updated: Jun 06, 2019
  • Author: Daniel R Ouellette, MD, FCCP; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Answer

Negative results on a high-sensitivity D-dimer test in a patient with a low pretest probability of pulmonary embolism indicate a low likelihood of venous thromboembolism and reliably exclude pulmonary embolism. A large, prospective, randomized trial found that in patients with a low probability of pulmonary embolism who had negative D-dimer results, forgoing additional diagnostic testing was not associated with an increased frequency of symptomatic venous thromboembolism during the subsequent 6 months. [48]

In a 2012 prospective cohort study, a Wells score of 4 or less combined with a negative qualitative D-dimer test was shown to safely exclude pulmonary embolism in primary care patients. [49]


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