D-dimer

Yeah, so it actually helps us to categorize patients into DBT likely or DBT unlikely, which helps to determine our next course of action.

Yeah, so sometimes we hear about something called the D-dimer testing.

So does anyone know what D-dimer testing is about?

So D-dimer is a fibrin degradation product.

And if the levels are elevated, it kind of suggests like there's a recent clot formation and breakdown, right?

Wow, Angela, that's amazing knowledge.

How do you learn that? Was it on placements?

I think like during vascular surgery, they all order like D-dimer just to test this out.

And, you know, we'll scan a lot of people because they said that, you know, radiates to their back and it's right between their shoulder blades like they looked it up online before they came in.

So fast forward 10 years to last summer, 2025, the clinical decision or clinical policy committee came out and said that Actually, we now have evidence based on the ADVISE trial and then subsequent trials that if you combine a low-risk aortic dissection detection risk score, the ADDRS, of one or less and a negative D-dimer, so less than 0.5 or 500, depending on your units, that, to quote the clinical policy, quote, emergency physicians can exclude acute non-traumatic aortic dissection without obtaining advanced imaging, meaning a CTA, an MRI, or a TE.

and talk about a practice-changing clinical policy.

I now can say and document in my note, this patient is low risk based on a validated clinical risk score.

They have a D-dimer less than 0.5. I'm done.

I don't have to scan them.

And again, the clinical policy committee took the time and did a 180 because of new evidence and said, we need to change our clinical policy based on new evidence.

And in the 20 minutes we've been talking, that's two ASAP clinical policies that change your practice.

And I will say, I hope that we see some pediatric versions of the wells or years come out so we get to come together and chat again.

You know, I do believe that the authors planned an evaluation of Wells and D-Dimer in children.

So hopefully we will get that study and other studies from this group.

Awesome.

Two types of kinda testing that you might hear about in, uh, this situation.

The first lab is a D-dimer.

That is a lab that is gonna look at, um, your blood clotting.

Now, it's great to tell us if we have a clot going on in general.