Contributor: Travis Barlock, MD

Educational Pearls:

D-dimer: fibrin degradation product used to evaluate for clot formation and breakdown
- Threshold: <500ng/mL rules out venous thromboembolism in low risk patients
- Elevated D-dimer indicates recent or ongoing intravascular coagulation and fibrinolysis
YEARS score: algorithm to assess PE risk using three clinical criteria
- Criteria: signs of DVT, hemoptysis, and PE as the most likely diagnosis
- YEARS score of 0 with D-dimer <1000 ng/mL: PE can be ruled out
- YEARS score of ≥1 with D-dimer <500 ng/mL: PE can be ruled out
- A study found that YEARS score accurately predicted the presence or absence of PE in 80% of enrolled patients with 90% sensitivity and 65% specificity
D-dimer may also help exclude aortic dissection: Aortic Dissection Detection Risk Score (ADD-RS)
- When ADD-RS = 0 or 1 and D-dimer <500ng/mL: aortic dissection may be ruled out in low-risk patients
- When ADD-RS >1, patients are considered high probability for aortic dissection and CT should be performed

References

Fayiad, H., Moussa, H., Nosair, Y. et al. Predictive accuracy of years score in diagnosis of pulmonary embolism. Egypt J Bronchol 18, 18 (2024). https://doi.org/10.1186/s43168-024-00269-y
Weitz JI, Fredenburgh JC, Eikelboom JW. A Test in Context: D-Dimer. J Am Coll Cardiol. 2017 Nov 7;70(19):2411-2420. doi: 10.1016/j.jacc.2017.09.024. PMID: 29096812.
Yichao Ma,Zhenjiang Ding,Yunong Zhao,Paijiao Zhang,Bo Du,Ye Shen,Junmei Hu,Luqi Zhu,Honghong Zhao,Chunrong Jin,Yuhong Wang,Lizhen Gao,Research progress on multi-marker detection technology for cardiovascular diseases (review), Journal of Electroanalytical Chemistry, 1008, (119969), (2026).

Summarized by Meg Joyce, MS2 | Edited by Meg Joyce & Jorge Chalit, OMS4

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Podcast 996: D-Dimer

Emergency Medical Minute