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. 2012 Oct;97(10):1507-13.
doi: 10.3324/haematol.2011.060657. Epub 2012 Apr 17.

Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded

Renée A Douma  1 , Melanie Tan, Roger E G Schutgens, Shannon M Bates, Arnaud Perrier, Cristina Legnani, Douwe H Biesma, Jeffrey S Ginsberg, Henri Bounameaux, Gualtiero Palareti, Marc Carrier, Gerben C Mol, Grégoire Le Gal, Pieter W Kamphuisen, Marc Righini
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Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded

Renée A Douma et al. Haematologica. 2012 Oct.

Abstract

Background: D-dimer testing to rule out deep vein thrombosis is less useful in older patients because of a lower specificity. An age-adjusted D-dimer cut-off value increased the proportion of older patients (>50 years) in whom pulmonary embolism could be excluded. We retrospectively validated the efficacy of this cut-off combined with clinical probability for the exclusion of deep vein thrombosis.

Design and methods: Five management study cohorts of 2818 consecutive outpatients with suspected deep vein thrombosis were used. Patients with non-high or unlikely probability of deep vein thrombosis were included in the analysis; four different D-dimer tests were used. The proportion of patients with a normal D-dimer test and the failure rates were calculated using the conventional (500 μg/L) and the age-adjusted D-dimer cut-off (patient's age x 10 μg/L in patients >50 years).

Results: In 1672 patients with non-high probability, deep vein thrombosis could be excluded in 850 (51%) patients with the age-adjusted cut-off value versus 707 (42%) patients with the conventional cut-off value. The failure rates were 7 (0.8; 95% confidence interval 0.3-1.7%) for the age-adjusted cut-off value and 5 (0.7%, 0.2-1.6%) for the conventional cut-off value. The absolute increase in patients in whom deep vein thrombosis could be ruled out using the age-adjusted cut-off value was largest in patients >70 years: 19% among patients with non-high probability.

Conclusions: The age-adjusted cut-off of the D-dimer combined with clinical probability greatly increases the proportion of older patients in whom deep vein thrombosis can be safely excluded.

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Figures

Figure 1.
Figure 1.
Proportion of patients with a normal D-dimer according to the conventional cut-off and age-adjusted cut-off. Data displayed for different agegroups among patients with a non-high clinical probability (cohorts 1-4, and cohorts 1-4 combined) or unlikely probability (cohort 5) for deep vein thrombosis.
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