Does age‐adjusted D‐Dimer have a role in assessment of VTE recurrence rates?

Abstract

IntroductionIt is known that D‐dimer levels increase with age and several studies have evaluated the use of an age‐adjusted (AA) cut‐off in the initial assessment of suspected venous thromboembolism (VTE). We performed a retrospective study to assess the effect that using an AA D‐dimer in the DASH score would have on the recommended duration of anticoagulant treatment for patients following a first unprovoked episode of VTE and then compared this with the advice that has been given to patients using a fixed cut‐off D‐dimer in the DASH score.MethodsData were collected for the period from April 2014 to October 2017. For each patient, the DASH score by a single cut‐off D‐dimer value (500 ng/mL) as well as an AA D‐dimer cut‐off value (D‐dimer cut‐off value equal to age in years × 10) was calculated for patients over 50 years. The Vienna prediction model was employed alongside this to compare the VTE recurrence risk using a well‐established method.ResultsA total of 204 patients were eligible for analysis, 145 of whom were over the age of 50 years. In 24 of these patients, the use of the AA D‐dimer made a significant impact on the predicted risk of recurrence using the DASH score and would have likely changed the recommendation to offer long‐term anticoagulation.ConclusionAs an age‐adjusted D‐dimer cut‐off has been assessed in the diagnostic setting, it would be logical and appropriate to also consider this philosophy in the prediction of the risk of recurrence of VTE following a first unprovoked event.