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Questioning Use of an Age-Adjusted D-Dimer Threshold to Exclude Venous Thromboembolism: Analysis of Individual Patient Data from Two Diagnostic Studies.
J Thromb Haemost. 2016 Jul 25;
Authors: Takach Lapner S, Julian JA, Linkins LA, Bates SM, Kearon C
Abstract
BACKGROUND: Using a progressively higher D-dimer level to exclude venous thromboembolism (VTE) with increasing age has been proposed but is not well validated.
OBJECTIVE: To determine if it is appropriate to use a progressively higher D-dimer level to exclude VTE with increasing age.
PATIENTS/METHODS: We analyzed clinical data and blood samples from 1649 patients with a first suspected deep vein thrombosis or pulmonary embolism. We compared the negative predictive value (NPV) for VTE, and the proportion of patients with a negative D-dimer result, using three D-dimer interpretation strategies: a progressively higher D-dimer threshold with increasing age ("Age-adjusted strategy"); the same higher D-dimer threshold in all patients ("Mean D-dimer strategy"); and a progressively higher D-dimer threshold with decreasing age ("Inverse age-adjusted strategy").
RESULTS: The NPV with the Age-adjusted strategy (99.6%; 95% confidence interval [CI] 99.0 to 99.9%) was not different from that of the Mean D-dimer strategy (99.7%; 95% CI, 99.0 to 99.9%) or the Inverse age-adjusted strategy (99.8%; 95% CI, 99.1 to 99.9%). The proportion of patients with a negative result with the Age-adjusted strategy (50.9%; 95% CI, 48.5 to 53.4%) was not different from that of the Mean D-dimer strategy (51.7%; 95% CI, 49.3 to 54.1%) or the Inverse age-adjusted strategy (49.5%; 95% CI, 47.1 to 51.9%).
CONCLUSIONS: Our analysis does not support use of a progressively higher D-dimer level to exclude VTE with increasing age. This article is protected by copyright. All rights reserved.
PMID: 27455175 [PubMed - as supplied by publisher]