Age-Adjusted D-Dimer to Rule out Deep Vein Thrombosis: Findings From the PALLADIO Algorithm

Riva, Nicoletta; Camporese, Giuseppe; Iotti, Matteo; Bucherini, Eugenio; Righini, Marc; Kamphuisen, Pieter Willem

doi:10.1016/j.jvsv.2018.05.014

Cited by 10 publications

(16 citation statements)

References 16 publications

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“…The results did not coincide with our research. In addition, some studies focused on the performance of age-adjusted D-dimer cut-off values for reducing the use of ultrasounds [3,14,15]. Broen et al inclined the view that age-adjusted D-dimer cut-off values can lead to less duplex ultrasounds performed to find patients that suffer from DVT [16].…”

Section: Discussionmentioning

confidence: 99%

Performance of age-adjusted D-dimer values for predicting DVT before the knee and hip arthroplasty

Qing

Yao

et al. 2021

J Orthop Surg Res

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Purpose To compare the specificity and sensitivity of preoperative D-dimer and age-adjusted D-dimer value for predicting the incidence of the DVT preoperatively in total joint arthroplasty (TJA) patients. Methods We enrolled 406 patients finally above 50 years old. Everyone had done ultrasonography bedside, and D-dimer concentrations were collected before surgery. The D-dimer and age-adjusted D-dimer cut-off was calculated by multiple logistic regression and receiver operating curve (ROC) analyses. Results A total of 39 patients had found asymptomatic deep vein thrombosis (DVT) by ultrasonography. The age (odds ratio [OR] 1.067; p = 0.003) and D-dimer (OR 1.331; p = 0.025) were related to the existence of DVT. For conventional D-dimer and age-adjusted D-dimer value, the area under the curves (AUCs) were 0.685 (0.499–0.696) and 0.795 (0.611–0.881), respectively. Conclusion Compared to traditional D-dimer, age-adjusted D-dimer showed better performance in screening DVT, which was useful clinically.

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Section: Discussionmentioning

confidence: 99%

Performance of age-adjusted D-dimer values for predicting DVT before the knee and hip arthroplasty

Qing

Yao

et al. 2021

J Orthop Surg Res

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“…40 All these diagnostic strategies were found to perform better than the conventional strategy. The diagnostic strategy based on an agespecific cut-off level calculated by multiplying the patient's age by 10 after 50 years, which has become widely used in clinical wards, 37 has been evaluated in various populations using different reagents (e.g., Schouten et al, 39,[47][48][49][50][51][52][53][54][55] ), but few data were available for the HemosIL D-dimer HS 500 assay. This strategy was found associated with an increased test specificity, without any significant decreased sensitivity and NPV.…”

Section: Discussionmentioning

confidence: 99%

Age‐adjusted D‐dimer cut‐off levels to rule out venous thromboembolism in patients with non‐high pre‐test probability: Clinical performance and cost‐effectiveness analysis

Pooter

Brionne-François

Smahi³

et al. 2021

Journal of Thrombosis and Haemostasis

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Background: As aging was found to be associated with increased D-dimer levels, the question arose whether D-dimer measurement was useful in the diagnostic strategy of venous thromboembolism (VTE) in elderly patients. Aim of the study:To compare retrospectively the performance of six diagnostic strategies based on the three-level Wells scores and various cut-off levels for D-dimer, evaluated using the HemosIL D-Dimer HS 500 assay, in a derivation cohort of 644 outpatients with non-high pretest probability (PTP) of VTE. The clinical usefulness of the best-performing strategy was then confirmed in a multicenter validation study involving 1255 consecutive outpatients with non-high PTP. Results:The diagnostic strategy based on the age-adjusted cut-off level calculated by multiplying the patient's age by 10 above 50 years was found to perform the best in the derivation study with a better sensitivity-to-specificity ratio than the conventional strategy based on the fixed cut-off level (500 ng/ml), a higher specificity and a negative predictive value (NPV) above 99%. Such an increase in test specificity was confirmed in the validation cohort, with the NPV remaining above 99%. Taking into account the local reimbursement rates of diagnostic tests, using this strategy led to a 6.9% reduction of diagnostic costs for pulmonary embolism and a 5.1% reduction for deep vein thrombosis, as imaging tests would be avoided in a higher percentage of patients. Conclusion:The diagnostic strategy of VTE based on the age-adjusted cut-off level for D-dimer in patients over 50 years was found to be safe, with NPV above 99%, and cost-effective.

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“…However, these genetic mutations are rare in Asian populations 23 . In addition, some possible risk factors for VTE such as age, smoking and in ammatory status are also reported to be associated with higher Ddimer [24][25][26] . Therefore, measurement of baseline D-dimer may provide comprehensive clinical information than assessment of some speci c thrombosis risk factors, such as genes or obesity.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for venous thromboembolism in patients with diabetes undergoing joint arthroplasty

Deng

Huo

Yuan

et al. 2020

Preprint

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Background: Venous thromboembolism (VTE) is a significant complication after joint arthroplasty. Diabetes is related to a few changes in coagulation and fibrinolysis that may lead to thrombophilia. We aim to investigate the incidence of and risk factors for VTEs in patients with diabetes undergoing total hip (THA) or total knee anthroplasty (TKA) in a single centre in China. Methods: Patients with diabetes who underwent THA or TKA from January 2016 to December 2018 (n=400) at Beijing Jishuitan Hospital were recruited in this study. Lower limb venous Doppler ultrasound was performed before and after surgery to confirm deep venous thrombosis (DVT). Computer tomography pulmonary angiography was done to confirm pulmonary embolism (PE) for those with new postoperative DVT and typical symptoms of PE. A multivariate logistic regression model was conducted to examine factors associated with the development of postoperative VTE. Results: The overall incidence of postoperative VTE in patients with diabetes after THA or TKA was 46.8% (187 of 400). Female patients and patients undergoing TKA had higher incidence of postoperative VTE. Patients who developed postoperative VTE were older, and had higher levels of preoperative D-Dimer level and Caprini score. Increased VTE risks were associated with high level of preoperative D-Dimer (OR=2.11, 95%CI=1.35-3.30) and TKA (OR=2.29, 95%CI=1.29-4.01). Postoperative initiation of concomitant mechanical prophylaxis and low molecular weight heparin (LMWH) was protective for postoperative DVT (OR=0.56, 95%CI=0.37-0.86). Conclusions: VTE is common in patients with diabetes undergoing joint arthroplasty. Patients undergoing TKA or with a high level of preoperative D-Dimer are at a considerable risk of developing postoperative VTE. There may be a protective role of postoperative initiation of concomitant mechanical prophylaxis and LMWH for VTE.

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Age-Adjusted D-Dimer to Rule out Deep Vein Thrombosis: Findings From the PALLADIO Algorithm

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Cited by 10 publications

References 16 publications

Performance of age-adjusted D-dimer values for predicting DVT before the knee and hip arthroplasty

Performance of age-adjusted D-dimer values for predicting DVT before the knee and hip arthroplasty

Age‐adjusted D‐dimer cut‐off levels to rule out venous thromboembolism in patients with non‐high pre‐test probability: Clinical performance and cost‐effectiveness analysis

Risk factors for venous thromboembolism in patients with diabetes undergoing joint arthroplasty

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