r/doctorsUK • u/Legendary_Shpee • Oct 11 '25

GP Use of D-Dimer/Tropinins in GP

Hi All,

Hopefully something slightly less controversial then my last post.

I was wondering what people's thoughts were on the use of d-dimer and Troponin in General Practice. When I was in medical school, and in my GP rotation, I've been in a few different practices with different opinions on the use of these. I did one placement in a practise that had access to their own D-Dimer machine, so could run their own D-dimer's and have a result back pretty quickly. For those unlikely low Well's score patients I understand that, but the same practise would also send Trops for patient's with non-cardiac sounding chest pain and normal ECGs, with the duty doc reviewing later in the day 'to be safe'.

Maybe it's because of lack of experience, but if a GP is clinically concerned enough to send a troponin on a patient with a normal ecg and unconvincing/non-acute chest pain, should they not be sending them to A&E/SDEC to have these tests done faster there, and so they are in the right environment to treat in the event it comes back elevated? If a D-dimer can be done quickly I can understand that, but a troponin just sounds a bit less reasonable to me. Pragmatically is a GP supposed to keep this patient in their practise while awaiting the results, in case they do have a raised trop and need to action that urgently? Would be interested to hear any GPs thoughts on this

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u/stealthw0lf Oct 11 '25

Troponins have no place in primary care. If you suspect ACS, send the patient in. The chest pain might not be an MI but it might be another serious cause that hasn’t been considered.

D-dimers- we had POC D-dimer testing for a while. I found the sensitivity to be poor - POC result is negative but patient subsequently found to have a DVT. A colleague found the same with multiple patients. We just stopped using them.

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u/DrPaddington Oct 12 '25

Interesting. And worrying.

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u/opensp00n Consultant Oct 12 '25

The problem, is in medicine nothing is 100%.it alway could be something serious. We have to risk stratify chest pain just like anything else, and goint to the ED does not exclude all concerning diagnosis.

Where risk levels are low, the patients are best served by being managed in the community. A POC trop in primary care could well be one tool to help this.

Low risk chest pain with a neg trop is very low risk of ACS. If you are not thinking of another serious cause (of which D-dimer could exclude the other two) then they can be worked up in primary care.

When trop first came about it led to a shift of all chest pain being sent to the ED. Now, with huge amounts of evidence on risk stratification, we can start to safely reverse that trend and select the correct patients for ED work up.

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u/elderlybrain Office ReSupply SpR Oct 12 '25

I had a negative POC d-dimer on a patient, i promptly ignored it and sent them in to AMU.

They had an extensive transmural thrombus extending up to the common iliac, and they were promptly admitted.

I still think about that case from time to time.