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May 11, 1994

Plasma D-Dimer Levels and Diagnosis of Pulmonary Embolism-Reply

Author Affiliations

Brigham and Women's Hospital Boston, Mass

JAMA. 1994;271(18):1404. doi:10.1001/jama.1994.03510420036029

In Reply.  —We emphasize, as do Drs Heit and Nichols, that in the diagnostic work-up of pulmonary embolism a quantitative plasma D-dimer ELISA should be used, rather than the more commonly employed but semi-quantitative latex agglutination assay. Though rapid and simple, the latex agglutination D-dimer is just not sufficiently sensitive to be useful clinically as a screening test for pulmonary embolism. (It is adequate, however, to test for disseminated intravascular coagulation.) Fortunately, skilled technologists can set up and perform the quantitative ELISA for D-dimer in about 4 hours. The resources and training required to use the D-dimer ELISA on short notice are substantial, but not nearly as demanding as the maintenance of around-the-clock availability of pulmonary angiography. Even at hospitals capable of performing angiography, it often takes 4 hours to orchestrate the logistics and to perform this invasive diagnostic test.We observed no difference (P=.78) in the average (±SD)

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