A Primer on Diagnostic and Financial Implications of D-dimer Testing.

Given the high incidence of deep vein thrombosis/pulmonary embolism (DVT/PE) (300,000 to 600,000 per year in the U.S.) and the 30 percent mortality rate associated with undiagnosed PE, diagnostic evaluation is very important. One of the tools used to evaluate for DVT and PE is D-dimer testing. A negative D-dimer test, along with a low Wells clinical probability score, can safely rule out DVT/PE without the need for additional imaging. This approach can reduce cost; however, D-dimer testing is not indicated in all patients. D-dimers can be elevated in patients without DVT/PE, like the elderly. The consequences of over utilizing D-dimer testing can lead to excessive imaging, unnecessary contrast exposure, unnecessary exposure to radiation, and increased cost. In this primer, we provide a brief literature review of D-dimer testing for the diagnosis of DVT and PE. We also discuss the overutilization of D-dimer testing and its financial burden on the health care industry.