The utility of routine D-dimer measurement in syncope

Aim To establish whether D-dimer is an independent predictor of 1-month serious outcome and all-cause death in syncope patients presenting to the emergency department (ED). Methods This was a prospective cohort study of all adults presenting with syncope to an ED in the UK. Plasma D-dimer concentrations were determined in citrated plasma obtained at presentation. The primary endpoint was the combination of serious outcome and all-cause death at 1 month. Results Of 237 patients enrolled, 205 patients had a suitable plasma sample and had complete follow-up. Seventeen patients had a serious outcome or death at 1 month including three patients with a pulmonary embolus and eight with a serious cardiovascular outcome. Nearly a half of all patients (n=94; 46%) had a plasma D-dimer concentration above the upper limit of normal, 10 of whom had a serious outcome or death at 1 month. Receiver-operator characteristic curve analysis showed no relationship between plasma D-dimer concentration and serious outcome or death at 1 month. An elevated plasma D-dimer concentration was found in all patients with a pulmonary embolus. Conclusion Plasma D-dimer is frequently raised in patients presenting with syncope to the ED and consequently does not predict 1-month serious outcome or death. We conclude that there is no role for the routine measurement of D-dimer in the management of patients presenting to the ED with syncope. European Journal of Emergency Medicine 16:256-260 (c) 2009 Wolters Kluwer Health vertical bar Lippincott Williams & Wilkins.