Age-related diagnostic value of D-dimer testing and the role of inflammation in patients with suspected deep vein thrombosis

Prochaska, Jürgen H.; Frank, Bernd; Nagler, Markus; Lamparter, Heidrun; Weißer, Gerhard; Schulz, Andreas; Eggebrecht, Lisa; Göbel, Sebastian; Arnold, Natalie; Panova‐Noeva, Marina; Hermanns, Iris; Pinto, Antônio V.; Konstantinides, Stavros; Cate, Hugo Ten; Lackner, Karl J.; Münzel, Thomas; Espinola‐Klein, Christine; Wild, Philipp S.

doi:10.1038/s41598-017-04843-x

Cited by 33 publications

(33 citation statements)

References 39 publications

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“…A study validating the manufacturers’ recommended cut‐off values in populations < 50 years old would be of interest, and this has recently been addressed by Proschaska et al . .…”

Section: Discussionmentioning

confidence: 99%

Age‐adjusted D‐dimer cut‐off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays

Farm

Siddiqui

Onelöv

et al. 2018

Journal of Thrombosis and Haemostasis

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Background The study compares different D-dimer assays and age-adjusted cut-offs in outpatients with suspected venous thromboembolism (VTE). The plasma concentration of this sensitive biomarker is increased by activated coagulation, but also by several conditions that are linked to an increased risk of VTE. One such condition is old age, which poses a common clinical problem where many prefer not to analyze D-dimer in elderly patients. Age-adjusted cut-offs have been validated for both deep venous thrombosis (DVT) and pulmonary embolism, aiming to increase specificity without notably decreasing sensitivity. Objectives We evaluated four common D-dimer assays in parallel, with and without applying age-adjusted cut offs for VTE. Patients/methods The prospective single-center study was conducted in 940 outpatients attending the emergency department with clinically suspected pulmonary embolism or DVT. Four automated D-dimer assays were compared (Siemens INNOVANCE , Roche Tina-quant, Medirox MRX and STA -Liatest D-Di PLUS). Results All assays performed with areas under the ROC curve (AUC) > 0.9 and maintained their sensitivities after implementation of age-adjusted cut-offs. Specificities increased by 6-7% and number needed to test decreased by < 0.3. The rate of false positive results decreased by 6% overall and by 10-20% for patients ≥ 70. Conclusions Age-adjusted cut-offs resulted in maintained high sensitivity and a modest improvement in specificity and number needed to test for all evaluated D-dimer assays. There was a significant reduction in false positive results, which reflects avoidable unnecessary imaging without any compromise of clinical safety. This suggests a potential to benefit the management of VTE in elderly patients, both clinically and economically.

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“…A study validating the manufacturers’ recommended cut‐off values in populations < 50 years old would be of interest, and this has recently been addressed by Proschaska et al . .…”

Section: Discussionmentioning

confidence: 99%

Age‐adjusted D‐dimer cut‐off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays

Farm

Siddiqui

Onelöv

et al. 2018

Journal of Thrombosis and Haemostasis

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“…Circulating D‐dimer is also elevated in patients with liver disease, coronary artery disease and other cardiovascular diseases, cancer, trauma, pregnancy, infections, inflammatory diseases, severe renal disease, recent surgical procedures, and advanced age as summarized in Table . However, the D‐dimer elevation in these conditions is less specific than for DVT/PE.…”

Section: Common Uses Of D‐dimer Assaysmentioning

confidence: 99%

The D‐dimer assay

2019

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D-dimer is an indirect marker of fibrinolysis and fibrin turnover; this molecule exhibits unique properties as a biological marker of hemostatic abnormalities as well as an indicator of intravascular thrombosis. D-dimer is a soluble fibrin degradation product that results from the systematic degradation of vascular thrombi through the fibrinolytic mechanism. Because of this, the D-dimer serves as a valuable marker of activation of coagulation and fibrinolysis in a number of clinical scenarios. Most commonly, D-dimer has been extensively investigated for excluding the diagnosis of venous thromboembolism (VTE) and is used routinely for this indication. In addition, D-dimer has been evaluated for determining the optimal duration of anticoagulation in VTE patients, for diagnosing and monitoring disseminated intravascular coagulation, and for monitoring other conditions in which the patient is at high risk of bleeding or thrombosis. Limitations of the assay include D-dimer elevation in a constellation of clinical scenarios (age, pregnancy, and cancer) and lack of clinical standardization.

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“…Baseline levels of D-dimer varied in different age due to variability in the in ammatory and immune response dependent on age (29)and the elders were more likely to suffering from stroke, which could explain why the speci city of a standard D-dimer cut-off at 500ug/L for DVT prediction in elderly patients with stroke was comparatively low. A systemic review indicated that utility of an age-adjusted D-dimer cut-off (patient's age*10)ug/L) for elderly patients for ruling out DVT was recommended (30). The average levels of D-dimer when DVT detected were about 4-fold as the levels of that on admission in our study, which suggested that the gradually increased level of d-dimer was associated with DVT.…”

Section: Analysis Of the Changes In Laboratory Variables When Dvt Detmentioning

confidence: 53%

Association of Clinical and Laboratory Variables with In-Hospital Incidence of Deep Vein Thrombosis in Patients with Acute Stroke: A Retrospective Study

Huang

Song

Peng

et al. 2020

Preprint

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Abstract Backgrounds: Deep vein thrombosis (DVT) is a serious complication in patients with acute stroke. Early prediction of DVT could enable physicians to perform a proper prevention strategy. We analyzed the association of clinical and laboratory variables with DVT to evaluate the risk of DVT in patients after stroke.Results: Acute stroke patients admitted to the Changsha Central Hospital between January 2016 and December 2019 with length of stay in hospital≥30 d were included. Clinical and laboratory variables for DVT at baseline were collected, and the diagnosis of DVT was confirmed by ultrasonography. Risk factors were developed by Multivariate logistic regression analysis. A total of 101 patients were included in the study, of which 77.2%(78/101) were diagnosed ischemic stroke and 22.8%(23/101)were confirmed hemorrhagic stroke. The overall incidence of DVT after acute stroke within 30 days was 19.8%(20/101). The level of D-dimer when DVT detected was significant increased than that on admission. Pulmonary infection and increased muscle tone as independent relevant factors for DVT were confirmed. Conclusions: Pulmonary infection as a risk factor and increased muscle tone as a protector factor for DVT were identified in patients after stroke and the significant change in level of D-dimer could be a warning for DVT occurrence. It helps with taking early managements to reduce the incidence of DVT in patients after stroke.

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Age-related diagnostic value of D-dimer testing and the role of inflammation in patients with suspected deep vein thrombosis

Cited by 33 publications

References 39 publications

Age‐adjusted D‐dimer cut‐off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays

Age‐adjusted D‐dimer cut‐off leads to more efficient diagnosis of venous thromboembolism in the emergency department: a comparison of four assays

The D‐dimer assay

Association of Clinical and Laboratory Variables with In-Hospital Incidence of Deep Vein Thrombosis in Patients with Acute Stroke: A Retrospective Study

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