Open AccessClinical applicability of D-dimer assay in the diagnosis of pulmonary embolism reduces with aging
Author(s) -
Luca Masotti,
Giancarlo Landini,
Fabio Antonelli,
Elio Venturini,
Roberto Cappelli,
Paola Rottoli
Publication year - 2007
Publication title -
clinical management issues
Language(s) - English
Resource type - Journals
eISSN - 2283-3137
pISSN - 1973-4832
DOI - 10.7175/cmi.v1i4.597
Subject(s) - medicine , d dimer , pulmonary embolism , clinical diagnosis , clinical practice , intensive care medicine , pediatrics , physical therapy
Despite modern algorithms have been proposed for diagnosis of pulmonary embolism (PE), it remains understimed and often missed in clinical practice, especially in elderly patients, resulting in high morbidity and mortality when early and correctly untreated. One of the main controversial issue is represented by the role and applicability of D-dimer in the diagnostic work up of geriatric patients. Most recent guidelines in young-adult patients suggest to perform D-dimer assay by ELISA or immunoturbidimetric methods only in non high pre-test clinical probability (PTP) patients; in these patients negative D-dimer can safely rule out the diagnosis of PE. This strategy is safe also in elderly patients; however the percentage of patients with non high PTP and negative D-dimer reduces progressively with age, making difficult its clinical applicability. The Authors, starting from two case reports, up date the diagnostic management of PE underling the limitations of D-dimer assay in elderly patients