Comparison of clinical probability-adjusted D-dimer and age-adjusted D-dimer interpretation to exclude venous thromboembolism

Sarah Takach Lapner; Jim A. Julian; Lori-Ann Linkins; Shannon M. Bates; Clive Kearon

doi:10.1160/TH17-03-0182

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2017; 117(10): 1937-1943
DOI: 10.1160/TH17-03-0182

Stroke, Systemic or Venous Thromboembolism

Schattauer GmbH

Comparison of clinical probability-adjusted D-dimer and age-adjusted D-dimer interpretation to exclude venous thromboembolism

Sarah Takach Lapner

¹Department of Medicine, University of Alberta, Edmonton, Alberta, Canada

²Department of Medicine, McMaster University, Hamilton, Ontario, Canada

,

Jim A. Julian

³Ontario Clinical Oncology Group, Hamilton, Ontario, Canada

,

Lori-Ann Linkins

²Department of Medicine, McMaster University, Hamilton, Ontario, Canada

⁴Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada

,

Shannon M. Bates

²Department of Medicine, McMaster University, Hamilton, Ontario, Canada

⁴Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada

,

Clive Kearon

²Department of Medicine, McMaster University, Hamilton, Ontario, Canada

⁴Thrombosis and Atherosclerosis Research Institute, Hamilton, Ontario, Canada

› Author Affiliations

Abstract

Summary

Two new strategies for interpreting D-dimer results have been proposed: i) using a progressively higher D-dimer threshold with increasing age (age-adjusted strategy) and ii) using a D-dimer threshold in patients with low clinical probability that is twice the threshold used in patients with moderate clinical probability (clinical probability-adjusted strategy). Our objective was to compare the diagnostic accuracy of age-adjusted and clinical probability-adjusted D-dimer interpretation in patients with a low or moderate clinical probability of venous thromboembolism (VTE). We performed a retrospective analysis of clinical data and blood samples from two prospective studies. We compared the negative predictive value (NPV) for VTE, and the proportion of patients with a negative D-dimer result, using two D-dimer interpretation strategies: the age-adjusted strategy, which uses a progressively higher D-dimer threshold with increasing age over 50 years (age in years × 10 µg/L FEU); and the clinical probability-adjusted strategy which uses a D-dimer threshold of 1000 µg/L FEU in patients with low clinical probability and 500 µg/L FEU in patients with moderate clinical probability. A total of 1649 outpatients with low or moderate clinical probability for a first suspected deep vein thrombosis or pulmonary embolism were included. The NPV of both the clinical probability-adjusted strategy (99.7%) and the age-adjusted strategy (99.6%) were similar. However, the proportion of patients with a negative result was greater with the clinical probability-adjusted strategy (56.1% vs, 50.9%; difference 5.2%; 95% CI 3.5% to 6.8%). These findings suggest that clinical probability-adjusted D-dimer interpretation is a better way of interpreting D-dimer results compared to age-adjusted interpretation.

Keywords

Venous thrombosis - D-dimer - diagnosis - sensitivity and specificity - humans

Full Text

References

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