Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded

Douma, Renée A.; Tan, Melanie; Schutgens, Roger E. G.; Bates, Shannon M.; Perrier, Arnaud; Legnani, Cristina; Biesma, Douwe H.; Ginsberg, Jeffrey S.; Bounameaux, Henri; Palareti, Gualtiero; Carrier, Marc; Mol, Gerben C.; Gal, Grégoire Le; Kamphuisen, Pieter Willem; Righini, Marc

doi:10.3324/haematol.2011.060657

Cited by 104 publications

(96 citation statements)

References 17 publications

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“…Righini et al (2000) found that the customary D-dimer test could rule out PE in 60% of patients aged<40 years, but in only 5% of patients aged>80. Douma et al (2012) developed a new D-dimer cut-off point in 2818 consecutive outpatients with suspected DVT. The new cut-off value was defined as (patient's age×10) μg/l in patients aged more than 50 years.…”

Section: Discussionmentioning

confidence: 99%

A New D-dimer Cutoff Value to Improve the Exclusion of Deep Vein Thrombosis in Cancer Patients

Chen¹,

Li²,

Liu³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Objective: To find a more appropriate alternative to D-dimer cutoff value for the diagnosis of deep vein thrombosis (DVT) in cancer patients. Methods: A total of 711 cancer patients with symptoms suspicious of DVT were included in the study. D-dimer levels were assessed using ELISA. All patients were subjected to imaging procedures. Results: Among 711 patients with cancer, 466 (65.5%) were females and 245 (34.5%) were males, with an average age of 57.3± 13.23 years. The mean age in the DVT group was significantly higher than in the non-DVT group (P<0.05). The D-dimer levels of the DVT group were significantly higher than those of the non-DVT group (P<0.05). The incidence rate of DVT varied significantly according to cancer type (P<0.05). Increasing age and lung cancer were significantly correlated with D-dimer levels (P<0.05), and a one-year increase in age was associated with a 14.28 ng/ml increase in the D-dimer value. The optimal cutoff point for D-dimer was found to be 981 ng/ml, with a sensitivity of 86.4%, specificity of 79.4%, and accuracy of 82.6%. If the D-dimer cutoff point was set to 981ng/ml, the specificity would increase from 61.8% to 85.5% without loss of sensitivity in patients aged 40 years or younger. In patients aged more than 40 years, the new cutoff almost doubled the specificity with slightly reduced sensitivity. Conclusion: In cancer patients, a new cutoff value of 981 ng/ml effectively improved the exclusion of DVT, especially for patients aged more than 40 years.

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Section: Discussionmentioning

confidence: 99%

A New D-dimer Cutoff Value to Improve the Exclusion of Deep Vein Thrombosis in Cancer Patients

Chen¹,

Li²,

Liu³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…The question of a higher D-dimer cut-off in elderly patients was raised a decade ago [34], but studies confirming the potential security of such a strategy by retrospectively applying age-adjusted cut-offs to large prospective cohorts of consecutive patients with suspected VTE were published between 2010 and 2012 [35][36][37][38][39]. A recent systematic review and meta-analysis of studies in patients with suspected VTE (PE and DVT) showed a dramatic decrease of the pooled specificity from 66.8% (95% CI 61.3-72) in patients b50 years to 14.7% (95% CI 11.3-18.6) in patients N80 years with the conventional D-dimer cut-off [40].…”

Section: Performance Of D-dimers In the Elderlymentioning

confidence: 99%

Diagnosis and management of pulmonary embolism in the elderly

Robert‐Ebadi

Righini

2014

European Journal of Internal Medicine

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a b s t r a c t a r t i c l e i n f oElderly patients are a population not only at particularly high risk of venous thromboembolism including pulmonary embolism (PE), but also at high risk of adverse clinical outcomes and treatment-related complications. Major progresses have been achieved in the diagnosis and treatment of PE over the last two decades. Nevertheless, some of elderly patients' specificities still represent important challenges in the management of PE in this population, from its suspicion to its diagnosis and treatment, and are discussed in this review. Perspectives for the future are from a diagnostic point of view the potential implementation of age-adjusted D-dimer cut-offs that will allow ruling out PE in a greater proportion of elderly patients without the need for thoracic imaging. From a therapeutic point of view, acquisition of post-marketing clinical experience with the use of new oral anticoagulants is still necessary, and in the meantime, these drugs should be prescribed with great caution in thoroughly selected elderly patients.

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“…Ancak testin pozitif olması DVT tanısı ile birlikte diğer tanı olasılıklarını da gündeme getirmektedir. Ayrıca ileri yaşlarda ve renal yetmezlik durumunda D-dimer seviyesinde artış olduğu da bilinmektedir [7,21]. Bizim yaptığımız çalışmada ise, orta ve yüksek olasılıklı PE olan hastalarda ortalama D-dimer düzeyleri, PE olmayan ve düşük olasılıklı gruba göre daha yüksek bulunmuş olmasına rağmen istatistiksel olarak anlamlı değildi.…”

Section: Bulgularunclassified

Pulmoner emboli tanısında D-dimer düzeyleri ile ventilasyon/perfüzyon sintigrafisindeki bulgular arasındaki ilişki

Hasbek¹,

Erselcan²,

Gül³

2014

Cumhuriyet Med J

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Amaç. Pulmoner emboli (PE) ölüm riskinin yüksek olması ve PE kuşkusu ile başlanan antikoagülan tedavinin yüksek kanama riski taşıması, tanının en kısa sürede doğrulanmasını ya da dışlanmasını gerektiren kardiovasküler hastalıktır. Ventilasyon/perfüzyon (V/P) sintigrafisi PE şüphesinde yaygın kullanılan testlerden biridir. D-dimer fibrin yıkımının bir ürünüdür. Ancak akut trombozlar için spesifik değildir. Bu çalışmada amacımız, D-dimer düzeyleri ile ventilasyon/perfüzyon sintigrafisindeki perfüzyon defekt sayısı arasındaki ilişkiyi araştırmaktı. Yöntem. Çalışmamızda, PE ön tanısı ile takip edilen 100 olgunun D-dimer düzeyleri ile V/P sintigrafileri arasındaki ilişki araştırıldı. Hastaların sintigrafik bulguları perfüzyon defekti açısından; "perfüzyon defekti yok", "subsegmenter tutulum", "bir segment tutulum", "iki segment tutulum", "üç segment tutulum" ve "üçten fazla segment tutulum" şeklinde altı gruba; pulmoner emboli olasılığı açısından ise "pulmoner emboli yok", "düşük olasılıklı", "orta olasılıklı" ve "yüksek olasılıklı" şeklinde dört gruba ayrıldı. D-dimer düzeyi referans aralığı 0,00-0,50 µg/mL idi. Bulgular. Çalışmaya alınan 100 hastanın 52'si erkek 48'i kadındı. Pulmoner emboli olmayan 65 hastada D-dimer: 4,39 ± 9 µg/mL; düşük olasılıklı 20 hastada D-dimer: 4,57 ± 4 µg/mL; orta olasılıklı olan 9 hastada D-dimer: 6,38 ± 6 µg/mL; yüksek olasılıklı olan 6 hastada D-dimer: 8.0 ± 8 µg/mL olarak bulundu (p>0,05). Perfüzyon defekti izlenen segment sayısına göre; perfüzyon defekti olmayan 22 hastada D-dimer: 3,01 ± 4 µg/mL; subsegmenter defekti olan 8 hastada Ddimer: 3,62 ± 3 µg/mL; 1 segment defekti olan 14 hastada D-dimer: 10,7 ± 18 µg/mL; 2 segment defekti olan 11 hastada D-dimer: 3,16 ± 2 µg/mL; 3 segment defekti olan 10 hastada D-dimer: 3,86 ± 3 µg/mL; 3'ten fazla segment defekti olan 35 hastada D-dimer: 4,66 ± 4 µg/mL olarak bulundu (p<0,05). Sonuç. D-dimer düzeyi ile ventilasyon/perfüzyon sintigrafisindeki sintigrafik bulguların ilişkisini incelediğimiz çalışmamızın sonucunda, D-dimer seviyesi bir segmentte perfüzyon defekti olan grupta yüksek, buna karşın üçten fazla segmentte tutulum olan grupta ise daha düşük olarak bulundu. Bu durum, tek segment defekti olan vakaların gerçek akut PE ile uyumlu vakalar olması ve daha fazla sayıda segment defekti olanların ise daha çok kronik hastalıkları bulunan vakalar olduğunu düşündürmektedir.Anahtar sözcükler: D-Dimer, pulmoner emboli, ventilasyon/perfüzyon sintigrafi Abstract Aim. Pulmonary embolism (PE) is a cardiovascular disease that the diagnosis is needed urgent recognition or exclusion, since the PE has high risk of death and anticoagulant treatment starting with suspicion of PE has high risk of bleeding. Ventilation/perfusion(V/P) scintigraphy is one of the widely used tests in suspect of PE. D-dimer is a product of fibrin degradation. However, it is not specific for acute thrombosis. The purpose of this study was to investigate the relation between number of the defect in the ventilation/perfusion scintigraphy and D-dimer levels. Method. In our study, t...

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Using an age-dependent D-dimer cut-off value increases the number of older patients in whom deep vein thrombosis can be safely excluded

Cited by 104 publications

References 17 publications

A New D-dimer Cutoff Value to Improve the Exclusion of Deep Vein Thrombosis in Cancer Patients

A New D-dimer Cutoff Value to Improve the Exclusion of Deep Vein Thrombosis in Cancer Patients

Diagnosis and management of pulmonary embolism in the elderly

Pulmoner emboli tanısında D-dimer düzeyleri ile ventilasyon/perfüzyon sintigrafisindeki bulgular arasındaki ilişki

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