Относительно недавно вышли рекомендации по ТЭЛА viewtopic.php?f=12&t=10446 Там д-димеру посвящена отдельная глава.
3.3 D-dimer testing
D-dimer levels are elevated in plasma in the presence of acute throm- bosis, because of simultaneous activation of coagulation and fibrin- olysis, The negative predictive value of D-dimer testing is high and a normal D-dimer level renders acute PE or DVT unlikely. On the other hand, fibrin is also produced in a wide variety of conditions such as cancer, inflammation, bleeding, trauma, surgery and necrosis. Accordingly, the positive predictive value of elevated D-dimer levels is low and D-dimer testing is not useful for confirmation of PE.
A number of D-dimer assays are available.110,111 The quantitative enzyme-linked immunosorbent assay (ELISA) or ELISA-derived assays have a diagnostic sensitivity of 95% or better and can therefore be used to exclude PE in patients with either a low or a moderate pre-test probability. In the emergency department, a negative ELISA D-dimer, in combination with clinical probability, can exclude the disease without further testing in approximately 30% of patients with suspected PE.100,112,113 Outcome studies have shown that the three-month thromboembolic risk was ,1% in patients left untreated on the basis of a negative test result (Table 5);99,112 – 116 these findings were confirmed by a meta-analysis.117
Quantitative latex-derived assays and a whole-blood agglutination assay have a diagnostic sensitivity ,95% and are thus often referred to as moderately sensitive. In outcome studies, those assays proved safe in ruling out PE in PE-unlikely patients as well as in patients with a low clinical probability.99,100,105 Their safety in ruling out PE has not been established in the intermediate clinical probability cat- egory. Point-of-care tests have moderate sensitivity, and data from outcome studies in PE are lacking, with the exception of a recent primary care-based study using the Simplify D-dimer assay,118 in which the three-month thromboembolic risk was 1.5% in PE-unlikely patients with a negative D-dimer.

То есть чувствительность 95 - это не 100! Но с другой стороны если д-димер отрицательный , тромбоэмболический риск 1,5% в течение 3 месяцев Проблема, что повышается у пожилых. Придумала специальная формула (age x 10 mg/L above 50 years) allowed increasing specificity from 34 – 46% while retaining a sensitivity
И заключительная фраза - The negative predictive value of a (negative) D-dimer test remains high in these situations.
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