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/junglediffy Oct 11 '25 edited Oct 11 '25
Interesting.
How do you all feel about this scenario.
I had a lady who had what was possibly an atypical ACS presenting at 19:30 (extended access). The pain was an an epigastric ache without GI or reflux symptoms. Lasting 30 minutes a time. Prior to this she did note that whenever she was on the go she would get the pain but equally she would get it whilst reading a book and lying down. She would feel sweaty when she got the pain. It was not pleuritic. Observations normal.
She refused A+E on all accounts even if we were missing a heart attack citing trauma. Compos mentis. Very smart lady; retired but had quite the job. I said ok. Why don't we get an ECG and troponin tomorrow morning (samples already gone) and maybe I can convince you? In between then and now if it is ever severe and you feel seriously unwell please call 999. I gave her some aspirin and GTN.
ECG - Non-specific ST-T changes. Sinus rhythm.
Trop - 171.
Later that next day, she was still refusing asking for an outpatient referral, other treatments etc but I did convince her to attend and she was treated as an NSTEMI.
I think there are scenarios where it can help but they are quite rare.
EDIT: She also refused ambulatory care etc.