Age-Adjusted D-Dimer Cut-off Levels to Rule-out Venous Thromboembolism in Patients with Non-High Pre-Test Probability. Clinical Performance and Cost-Effectiveness Analysis

This article was originally published here

J Thromb Haemost. 2021 Feb 26. doi: 10.1111/jth.15278. Online ahead of print.

ABSTRACT

BACKGROUND: As ageing was found to be associated with increased D-dimer levels, the question arose whether D-dimer measurement was useful in the diagnostic strategy of venous thromboembolism (VTE) in elderly patients.

AIM OF THE STUDY: To compare retrospectively the performance of six diagnostic strategies based on the three-level Wells scores and various cut-off levels for D-dimer, evaluated using the HemosIL D-Dimer HS 500 assay, in a derivation cohort of 644 outpatients with non-high pretest probability (PTP) of VTE. The clinical usefulness of the best performing strategy was then confirmed in a multicenter validation study involving 1,255 consecutive outpatients with non-high PTP.

RESULTS: The diagnostic strategy based on the age-adjusted cut-off level calculated by multiplying the patient’s age by 10 above 50 years was found to perform the best in the derivation study with a better sensitivity-to-specificity ratio than the conventional strategy based on the fixed cut-off level (500 ng/mL), a higher specificity and a negative predictive value (NPV) above 99%. Such an increase in test specificity was confirmed in the validation cohort, with the NPV remaining above 99%. Taking into account the local reimbursement rates of diagnostic tests, using this strategy led to a 6.9%-reduction of diagnostic costs for PE and a 5.1%-reduction for DVT, as imaging tests would be avoided in a higher percentage of patients.

CONCLUSION: The diagnostic strategy of VTE based on the age-adjusted cut-off level for D-dimer in patients over 50 years was found to be safe, with NPV above 99%, and cost-effective.

PMID:33638267 | DOI:10.1111/jth.15278