increasing the threshold from conventional levels, but we do not believe that age-adjustment is the best way to do this. To increase the yield of D-dimer for diagnostic testing, we support exclusion of VTE with a higher D-dimer threshold in patients with a low clinical probability for VTE (clinical probability-adjusted interpretation) rather than in older patients [3][4][5].
Disclosure of Conflict of InterestsWhile conducting the original study, but more than 36 months prior to publication, S. Bates received consulting fees from Trinity Biotech. The other authors state that they have no conflict of interest. References 1 Takach Lapner S, Julian JA, Linkins LA, Bates SM, Kearon C. Questioning use of an age-adjusted D-dimer threshold to exclude venous thromboembolism: analysis of individual patient data from two diagnostic studies. J Thromb Haemost 2016; 14: 1953-59.2 Kraaijpoel N, Toorop M, Bossuyt PM, Klok FA, Buller HR, van Es N. Questioning the use of an age-adjusted D-dimer threshold to exclude venous thromboembolism: comment. J Thromb Haemost 2018; 16: 1445-8. 3 van der Hulle T, Cheung WY, Kooij S, Beenen LFM, van Bemmel T, van Es J, Faber LM, Hazelaar GM, Heringhaus C, Hofstee H, Hovens MMC, Kaasjager KAH, van Klink RCJ, Kruip M, Loeffen RF, Mairuhu ATA, Middeldorp S, Nijkeuter M, van der Pol LM, Schol-Gelok S, et al.; YEARS study group. Simplified diagnostic management of suspected pulmonary embolism (the YEARS study): a prospective, multicentre, cohort study. Lancet 2017; 390: 289-97.