5 years ago

Age-adjusted D-dimer to rule out deep vein thrombosis: findings from the PALLADIO algorithm

James D. Douketis, Matteo Iotti, Marc Righini, Paolo Prandoni, Eugenio Bucherini, Nicoletta Riva, Walter Ageno, Giuseppe Camporese, Chiara Tonello, Peter Verhamme, , Pieter W. Kamphuisen
Background Age-adjusted D-dimer has been proposed to increase specificity for the diagnosis of venous thromboembolism (VTE). However, the accuracy of this threshold has been recently questioned. Objectives To assess the diagnostic performance of age-adjusted D-dimer combined with clinical pre-test probability (PTP) in patients with suspected deep vein thrombosis (DVT). Methods PALLADIO (NCT01412242) was a multicentre management study that validated a new diagnostic algorithm, incorporating PTP, D-dimer (using manufacturers’ cut-off), and limited or extended compression ultrasonography (CUS) in outpatients with clinically suspected DVT. Patients with unlikely PTP and negative D-dimer had DVT ruled out without further testing (group 1); patients with likely PTP or positive D-dimer underwent limited-CUS (group 2); patients with likely PTP and positive D-dimer underwent extended-CUS (group 3). Patients with DVT ruled out at baseline had a 3-month follow-up. In this post-hoc analysis we evaluated age-adjusted D-dimer cut-off (defined as age times 10μg/L, or age times 5μg/L for D-dimers with lower manufacturers’ cut-off, in patients >50 years). Results 1162 patients were enrolled. At initial visit, DVT were detected in 4.0% of patients in group 2 and 53.0% in group 3. The age-adjusted D-dimer, compared to the fixed cut-off, resulted in 5.1% (95%CI, 4.0-6.5%) reduction of CUS. The incidence of symptomatic VTE during follow-up was: 0.24% (95%CI, 0.04-1.37) in group 1; 1.12% (95%CI, 0.44-2.85) in group 2; 1.89% (95%CI, 0.64-5.40) in group 3. Conclusions The PALLADIO algorithm using age-adjusted D-dimer slightly decreased the number of required imaging tests, but this approach should be confirmed in large management studies. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/jth.13905

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