Dataset Information

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

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 ?g/L) and the age-adjusted D-dimer cut-off (patient's age x 10 ?g/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.

SUBMITTER: Douma RA

PROVIDER: S-EPMC3487551 | biostudies-literature | 2012 Oct

REPOSITORIES: biostudies-literature

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Publications

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

Douma Renée A RA Tan Melanie M Schutgens Roger E G RE Bates Shannon M SM Perrier Arnaud A Legnani Cristina C Biesma Douwe H DH Ginsberg Jeffrey S JS Bounameaux Henri H Palareti Gualtiero G Carrier Marc M Mol Gerben C GC Le Gal Grégoire G Kamphuisen Pieter W PW Righini Marc M

Haematologica 20120417 10

<h4>Background</h4>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.<h4>Design and methods</h4>Five management study cohorts of 2818 consecutive outpatients with ...[more]

PMID: 22511491

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Project description:ObjectiveTo determine whether the use of age adapted D-dimer cut-off values can be translated to primary care patients who are suspected of deep vein thrombosis.DesignRetrospective, cross sectional diagnostic study.Setting110 primary care doctors affiliated with three hospitals in the Netherlands.Participants1374 consecutive patients (936 (68.1%) aged >50 years) with clinically suspected deep vein thrombosis.Main outcome measuresProportion of patients with D-dimer values below two proposed age adapted cut-off levels (age in years × 10 μg/L in patients aged >50 years, or 750 μg/L in patients aged ≥ 60 years), in whom deep vein thrombosis could be excluded; and the number of false negative results.ResultsUsing the Wells score, 647 patients had an unlikely clinical probability of deep vein thrombosis. In these patients (at all ages), deep vein thrombosis could be excluded in 309 (47.8%) using the age dependent cut-off value compared with 272 (42.0%) using the conventional cut-off value of 500 μg/L (increase 5.7%, 95% confidence interval 4.1% to 7.8%). This exclusion rate resulted in 0.5% and 0.3% false negative cases, respectively (increase 0.2%, 0.004% to 8.6%).The increase in exclusion rate by using the age dependent cut-off value was highest in the oldest patients. In patients older than 80 years, deep vein thrombosis could be safely excluded in 22 (35.5%) patients using the age dependent cut-off value compared with 13 (21.0%) using the conventional cut-off value (increase 14.5%, 6.8% to 25.8%). Compared with the age dependent cut-off value, the cut-off value of 750 μg/L had a similar exclusion rate (307 (47.4%) patients) and false negative rate (0.3%).ConclusionsCombined with a low clinical probability of deep vein thrombosis, use of the age dependent D-dimer cut-off value for patients older than 50 years or the cut-off value of 750 μg/L for patients aged 60 years and older resulted in a considerable increase in the proportion of patients in primary care in whom deep vein thrombosis could be safely excluded, compared with the conventional cut-off value of 500 μg/L.

Dataset Information

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

Background

Design and methods

Results

Conclusions

Publications

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

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