Is it possible to have a pulmonary embolism with a negative D-dimer test?

Q. Will Aspirin affect D-dimer test?

Answered by
Dr. Sadaf Mustafa
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Aug 26, 2017 and last reviewed on: Jul 31, 2023

Hi doctor,

My pain started behind knee, but now is causing recurrent chest pains and shortness of breath. I could not do much physical activity. There is no previous history of such event. I am currently on Aspirin. I had an EKG, lung x-ray and D-dimer blood test. Is it possible to have a pulmonary embolism with negative D-dimer test? If the clot breaks or moving, then will D-dimer work? What else could cause pulmonary embolism like symptoms?



Welcome to D-dimer is a very desirable indicator of clot formation. It may be positive even if you do not have a pulmonary embolism. But, if D-dimer is normal, then a pulmonary embolism is unlikely the cause of your symptoms. The symptoms of PEcan be quite severe and may include sudden onset of chest pain, shortness of breath, dizziness, and syncope (passing out). These symptoms can mimic other lung problems and cardiac issues, making it important to consider a PE as a potential cause. However, it's worth noting that a positive D-dimer test, which indicates clot formation, can occur in situations other than a pulmonary embolism. On the other hand, if the D-dimer test comes back normal, it suggests that a pulmonary embolism is unlikely to be the cause of the symptoms. To further understand your situation, it would be helpful to know more about the duration of your chest pain and shortness of breath.

Thank you doctor,

I have chest pain, shortness of breath and lightheadedness. I can feel something constantly pulsating in my body that moves around. It started in the back of my leg behind my knee after a workout outside in the 100 degree heat. Now, the pulsating was not behind the knee, but moves around my body. I can feel it as traveling around in my neck area, chest area, then travel into my head and cause a lot of pressure and then will move around my body, leg, arms and back. I have these feeling for the past six weeks. After an EKG, my doctor said it looked fine and no stress test had been done. I did not get any scan.

I cannot drink hot beverages without flushing and tingling sensation, get cold very easily, hot shower feels like it opens up my lungs and cannot run or lift weights. I feel as if the pulsatile feeling cut off the circulation of blood to my head multiple times, then when the pressure got too much it my face, neck and hand on the left side started to go numb. It passed through my heart at multiple times and made my heart stop for a second and then it pushed whatever it is through. I could feel it being pushed through. On two occasions, my legs felt like they were in the water when trying to move them and they tingled as if asleep. Will 10 to 12 Aspirin a day affect the D-dimer test?



Welcome back to Taking an excessive amount of Aspirin can be highly detrimental as it may lead to an overdose and increase the risk of bleeding due to platelet dysfunction. Symptoms of a pulmonary embolism (PE) can include tachypnea (increased respiratory rate), tinnitus, nausea, vomiting, hyperthermia (elevated temperature), altered mental status, and fluid in the lungs. It's crucial to recognize that D-dimer alone should not be solely relied upon for diagnosing a pulmonary embolism, as approximately 5% of patients with moderate to high clinical suspicion for PE may have normal D-dimer levels. Aspirin primarily affects platelet interaction rather than clot formation, and in some cases, it may even raise D-dimer levels. To gain a better understanding of your situation, it's essential to know if you smoke, have a family history of pulmonary embolism or deep vein thrombosis, experience constant numbness and tingling, and have been tested for hyperthyroidism and vitamin B12 deficiency. Additionally, information about alcohol consumption, blood pressure levels, fluctuations, and circumstances surrounding any episodes of passing out would be beneficial. Also, it would be pertinent to know if your chest x-ray was normal and D-dimer levels were within the expected range.

Hello doctor,

Thanks for the response.

I do not smoke or consume alcohol. I have a family history of pulmonary embolism. The numbness and tingling sensation were not constant, and I had it twice in the sleep and one more time at noon. It is usually over 118, but I can not remember the other value. I passed out after standing up from a chair, and my chest x-ray was normal.

Thank you.



Welcome back to

The chances of pulmonary embolism are less, but I would not completely exclude it. You would benefit from getting a ventilation/perfusion scan that looks for a ventilation and perfusion mismatch. I would also suggest getting your vitamin B12 levels and thyroid-stimulating hormone levels checked. The dizziness is due to postural hypotension. I would recommend checking your blood pressure levels in a sitting position and, three minutes later, in a standing position.

Please share those values with me.

Thank you.

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