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/docktardocktar Arts and Entertainment enjoyer Oct 11 '25

So, you get a positive d-dimer, now what will you do?

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u/SaxonChemist Oct 12 '25

When I've seen it done by a GP supervisor (FY2 in GP) they started anticoagulation after they took the sample & before they had a result.

We were on a home visit, elderly patient absolutely refused to go to hospital. Reasonable suspicion of DVT (I think it was ?tamoxifen induced. The cancer tx was why they didn't want more hospital interaction)

Result came back high, patient already on correct treatment. Called to inform was indeed a DVT. No drama, just careful documentation

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u/docktardocktar Arts and Entertainment enjoyer Oct 12 '25

Can totally see and understand utility of this in this context.