The threshold for D-dimer remains an important topic in emergency medicine, critical care, and pulmonology. Emerging evidence, particularly from the 4-Level Pulmonary Embolism Clinical Probability Score (4PEPS) introduced by Roy et al., suggests that we may need to adjust risk stratification and corresponding D-dimer thresholds. Recent data published in The Lancet Respiratory Medicine indicate that a threshold of 1000 ng/mL can safely exclude pulmonary embolism in patients for whom PE is not the most likely diagnosis, while an age-adjusted threshold remains appropriate for other patients. These findings highlight a potential shift toward individualized thresholds based on clinical probability rather than a single universal cutoff.