PEGeD

Pulmonary Embolism Graduated D-dimer strategy (Kearon 2019). Three-level Wells clinical pre-test probability: low (0–4) → PE excluded if D-dimer < 1000 µg/L; moderate (4.5–6) → < 500 µg/L; high (> 6) → imaging. It reduced CTPA use from 52% to 34% with a 3-month VTE rate of 0.05% in patients not diagnosed with PE.

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Wells score (three-level clinical pre-test probability)

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D-dimer

µg/L FEU

µg/L = ng/mL; mg/L = µg/mL. DDU assays: roughly double the value to get FEU.

Wells 0 · Low C-PTP (Wells 0–4)

< 1000

D-dimer (µg/L) that excludes PE

D-dimer cut-off at this probability: 1000 µg/L FEU

Decision guide

Why use it
PEGeD reduced imaging to 34% of outpatients (vs 52% with Wells and a fixed 500 µg/L cut-off) without missing more PE. It was not validated in pregnancy or in patients already on anticoagulation.

References