D-dimer testing in elderly patients in primary care for exclusion of venous thromboembolism

The exclusion of deep venous thrombosis (DVT) in the elderly is hampered by low specificity in clinical decision of D-dimer assays in older patients. To reduce false-positive results, we evaluated specific fibrin(ogen) degradation product assays for their contribution in the diagnosis of DVT. In a post-hoc study with outpatients suspected for DVT, we evaluated the elastase-specific fibrinogen (fibrinogen elastase degradation product, FgEDP) and D-E-specific fibrin (fibrin degradation product, FbDP) degradation product assays in relation to DVT. Results were combined with five D-dimer assays as ratio, with a specific focus on age-dependency. In 437 patients (DVT prevalence 39%), FgEDP correlated with D-dimer in DVT-negative patients (P<0.001), but not in DVT-positive patients (P > 0.55). FbDP results correlated with D-dimer in both groups (P<0.001). The values of the area under the curve of the receiver operating characteristic curve for both assays were lower than D-dimer. Using the ratios, only in the fourth age quartile D-dimer/FgEDP ratios had diagnostic value with lower number needed to test (1.8-12.7) as compared to D-dimer less than 500 μg/l alone (5.4-102). The D-dimer/FbDP ratios in DVT-negative elderly patients increased to a plateau by increasing D-dimer. In DVT-positive patients, these ratios were near constant for increasing values of D-dimer. In elderly patients, the D-dimer/FgEDP ratios may improve the number of patients in whom DVT could be excluded. The D-dimer/FbDP ratios showed differences in composition of fibrin degradation products between DVT-negative and DVT-positive patients and between young and old DVT-negative patients.

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D-dimer testing in elderly patients in primary care for exclusion of venous thromboembolism

Abstract: To cite this article: Siccama RN, Janssen KJM, Oudega R, van Delden JJM, Moons KGM. D-dimer testing in elderly patients in primary care for exclusion of venous thromboembolism.

Cited by 2 publications

References 12 publications

Systematic review: Diagnostic accuracy of clinical decision rules for venous thromboembolism in elderly

Systematic review: Diagnostic accuracy of clinical decision rules for venous thromboembolism in elderly

Diagnostic possibilities of specific fibrin(ogen) degradation products in relation to venous thromboembolism

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