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      We thank Dr Zalmay et al for giving us the opportunity to respond to their concerns. The aim of our study
      • Nickel CH
      • Kellett J
      • Cooksley T
      • et al.
      The diagnoses and outcomes of emergency patients with an elevated D-dimer over the next 90 days.
      was to examine the diagnoses and outcomes of acute medical patients with an elevated D-dimer. Our results confirm that patients with normal D-dimer levels are unlikely to die within 90 days, and that elevated D-dimer levels are not only associated with an increased risk for venous thromboembolism, but are also associated with infection, cancer, heart failure, and anemia. Our results confirm that D-dimer is a nonspecific test, and therefore, is of little diagnostic value in an unselected patient population, but is of prognostic value. This leads us to speculate, but not conclude, that D-dimer could be used as a prognostic marker. The main concern against routine measurement of D-dimers on every emergency department patient is that it would result in superfluous downstream investigations. However, in an observational trial during the current COVID-19 pandemic, in which a third of Danish emergency departments participated, routine measurement of D-dimers in more than 500,000 visits did not result in increased unnecessary radiological investigations.
      • Brabrand M
      • Bogh SB
      • Fløjstrup M
      • Kellett J
      • Cooksley T
      • Nickel CH
      Routine measurement of d-dimers on suspected SARS-CoV2-infected patients does not lead to significant increase in radiological investigations.
      We, of course, agree with Zalmay et al that the jury is still out on routine use of the D-dimer in acute medical illness, and that large multicenter trials will be needed to prove that routine D-dimer measurement leads to improved outcomes.

      References

        • Nickel CH
        • Kellett J
        • Cooksley T
        • et al.
        The diagnoses and outcomes of emergency patients with an elevated D-dimer over the next 90 days.
        Am J Med. 2021; 134: 260-266.e2
        • Brabrand M
        • Bogh SB
        • Fløjstrup M
        • Kellett J
        • Cooksley T
        • Nickel CH
        Routine measurement of d-dimers on suspected SARS-CoV2-infected patients does not lead to significant increase in radiological investigations.
        Intern Emerg Med. 2021 Jan 1; ([online ahead of print]): 1-2https://doi.org/10.1007/s11739-020-02568