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Limited value of the D-dimer based YEARS algorithm to rule out pulmonary embolism in sickle cell disease and sickle cell trait Further research is needed to establish whether an altered SCD-specific PERC rule might be more suitable in ruling out PE in patients with SCD. Sickle cell disease (SCD) is associated with hypercoagulability and an increased risk of venous thromboembolism (VTE) including pulmonary embolism (PE).1-4 In patients with SCD, overlapping symptoms between PE and acute complications such as vaso-occlusive crisis (VOC) and/or acute chest syndrome lead to diagnostic challenges.5 Therefore, reliable diagnostic algorithms to rule out PE and avoid the frequent use of computed tomography pulmonary angiography (CTPA) are urgently needed for patients with SCD.6 In patients without SCD with clinically suspected PE, D-dimer-based PE algorithms are recommended. CTPA could be withheld in only 7% of patients with SCD and 24% of HbAS individuals, while the YEARS algorithm can safely avoid a CTPA in 48% of unselected individuals with clinically suspected PE.14 It is therefore vital to develop diagnostic algorithms for patients with SCD that are not based on D-dimer levels. [Extracted from the article]

Competing Interests: Declaration of competing interests N.v.E. has received speaker fees from Bristol-Myers-Squibb, which were transferred to his institute. A.S. declares no competing interests.