Clinical applicability of D-dimer assay in the diagnosis of pulmonary embolism reduces with aging

Clinical applicability of D-dimer assay in the diagnosis of pulmonary embolism reduces with aging

Authors

  • Luca Masotti U.O. Medicina Interna, Ospedale di Cecina, ASL 6 Livorno. Dipartimento di Medicina Clinica e Scienze Immunologiche, Sezione di Malattie dell’Apparato Respiratorio, Università degli Studi di Siena
  • Giancarlo Landini U.O. Medicina Interna, Ospedale di Cecina, ASL 6 Livorno
  • Fabio Antonelli U.O. Chimica Clinica, Ospedale di Cecina, ASL 6 Livorno
  • Elio Venturini U.O. Cardiologia, Ospedale di Cecina, ASL 6 Livorno
  • Roberto Cappelli Dipartimento di Medicina Interna, Cardiovascolare e Geriatrica, Università degli Studi di Siena
  • Paola Rottoli Dipartimento di Medicina Clinica e Scienze Immunologiche, Sezione di Malattie dell’Apparato Respiratorio, Università degli Studi di Siena

DOI:

https://doi.org/10.7175/cmi.v1i4.597

Keywords:

D-dimer, Clinical probability, Pulmonary embolism, Diagnosis, Elderly

Abstract

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.

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Published

2007-12-15

Issue

Vol. 1 No. 4 (2007)

Section

Case report

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