Questioning the use of an age‐adjusted D‐dimer threshold to exclude venous thromboembolism: analysis of individual patient data from two diagnostic studies

Essentials It is unclear if raising the D‐dimer level to exclude venous thrombosis in older patients is valid. We compared this ‘age‐adjusted’ strategy with other ways of interpreting D‐dimer results. A non‐age adjusted increase, and using higher thresholds in younger patients, was just as accurate. Age‐adjustment of D‐dimer thresholds does not appear to be appropriate.

[1]  G. Palareti,et al.  Validation of STA-Liatest D-Di assay for exclusion of pulmonary embolism according to the latest Clinical and Laboratory Standard Institute/Food and Drug Administration guideline. Results of a multicenter management study , 2016, Blood coagulation & fibrinolysis : an international journal in haemostasis and thrombosis.

[2]  J. Douketis,et al.  Rapid quantitative D‐dimer to exclude pulmonary embolism: a prospective cohort management study , 2016, Journal of thrombosis and haemostasis : JTH.

[3]  O. Rutschmann,et al.  Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. , 2014, JAMA.

[4]  J. Reitsma,et al.  Diagnostic accuracy of conventional or age adjusted D-dimer cut-off values in older patients with suspected venous thromboembolism: systematic review and meta-analysis , 2013, BMJ.

[5]  Jeremy Voros Selective D-dimer Testing for Diagnosis of a First Suspected Episode of Deep Venous Thrombosis: A Randomized Trial , 2013 .

[6]  A. Kosinski A weighted generalized score statistic for comparison of predictive values of diagnostic tests , 2013, Statistics in medicine.

[7]  C. Legnani,et al.  Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded , 2012, Haematologica.

[8]  R. Newcombe,et al.  Confidence Intervals for Proportions and Related Measures of Effect Size , 2012 .

[9]  J. Kline,et al.  Performance of age‐adjusted D‐dimer cut‐off to rule out pulmonary embolism , 2012, Journal of thrombosis and haemostasis : JTH.

[10]  K. Moons,et al.  Validation of two age dependent D-dimer cut-off values for exclusion of deep vein thrombosis in suspected elderly patients in primary care: retrospective, cross sectional, diagnostic analysis , 2012, BMJ : British Medical Journal.

[11]  Johannes B. Reitsma,et al.  Clinical Decision Rules for Excluding Pulmonary Embolism: A Meta-analysis , 2011, Annals of Internal Medicine.

[12]  H. Büller,et al.  Potential of an age adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts , 2010, BMJ : British Medical Journal.

[13]  B. Polack,et al.  Discordant D‐dimer results of two rapid quantitative automated assays are related to age , 2008, Journal of thrombosis and haemostasis : JTH.

[14]  H R Büller,et al.  Diagnostic accuracy of D‐dimer test for exclusion of venous thromboembolism: a systematic review , 2007, Journal of thrombosis and haemostasis : JTH.

[15]  S. Doucette,et al.  Does this patient have deep vein thrombosis? , 1998, JAMA.

[16]  A. Agresti,et al.  Simple improved confidence intervals for comparing matched proportions , 2005, Statistics in medicine.

[17]  L. Frederico Combined use of rapid D-dimer testing and estimation of clinical probability in the diagnosis of deep vein thrombosis: systematic review , 2004, BMJ : British Medical Journal.

[18]  Jonathan Dreyer,et al.  Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. , 2003, The New England journal of medicine.

[19]  B. Hunt,et al.  A clinical probability assessment and D-dimer measurement should be the initial step in the investigation of suspected venous thromboembolism. , 2003, Chest.

[20]  H. Nieuwenhuis,et al.  The usefulness of five d‐dimer assays in the exclusion of deep venous thrombosis , 2003, Journal of thrombosis and haemostasis : JTH.

[21]  H. Bounameaux,et al.  Effects of age on the performance of common diagnostic tests for pulmonary embolism. , 2000, The American journal of medicine.

[22]  M. Pepe,et al.  Comparisons of Predictive Values of Binary Medical Diagnostic Tests for Paired Designs , 2000, Biometrics.

[23]  M Gent,et al.  Derivation of a Simple Clinical Model to Categorize Patients Probability of Pulmonary Embolism: Increasing the Models Utility with the SimpliRED D-dimer , 2000, Thrombosis and Haemostasis.