52 M come to ER with a suspected DVT in leg. US was negative | Figure 1

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52 M come to ER with a suspected DVT in leg. US was negative and patient was discharged. As he was walking to parking lot patient collapsed and hit head. Did CT on head and a PE study. Pt has a saddle PE and subdural hematoma.

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Enlighten me if I'm off track:

Again, you must be prepared to interpret an elevated D-dimer level before requesting the assay. More often than not, clinicians avoid the test because of the perception that they are medicolegally bound to investigate raised D-dimers, so they prefer not to know! A negative D-dimer test is very helpful in excluding thromboembolism in low-risk patients, however ignoring a positive result without follow-up requires clinical authority. When asking to know D-dimer levels, be prepared to go all the way: initiate treatment and request CT pulmonary angiography and Doppler ultrasonography if suspecting PE and DVT, respectively. A negative D-dimer test is useless in a high risk PE/DVT patient, so do not request it in the first place! Treat the patient and organize imaging without hesitation.

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