Hi George, I am wondering if anyone is using the age-related D-dimer cutoff for the emergency room based on the ADJUST-PE study? We use Innovance D-dimer reagents from Siemens on the BCS XP analyzer. Our ER physicians are very impatient for us to allow them to use this age-adjusted cut-off, but we have reservations due to CAP and CLIA regulations. Thanks, Sylvia Stacy, Concord Hospital, Concord, NH.
Hello, Sylvia, and thank you for your question. Judging by the number of recent publications, the use of the age-adjusted D-dimer cutoff to rule out pulmonary embolism (PE ) — defined as age X 10 for patients over 50, and reported as ng/mL or ug/L Fibrinogen Equivalent Units–is gathering momentum. The article that reports the ADJUST-PE results is Righini M, Van Es J, Den Exter P, et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism. JAMA 2014;311:1117–24, and is attached below. Another compelling article that generalizes age-related cutoffs to all venous thromboembolic disease is Lippi G, Favaloro EJ, Cervellin G. A review of the value of D-dimer testing for prediction of recurrent venous thromboembolism with increasing age. Semin Thrombos Hemostas 2014;40:634–9.
I’ll be interested in learning from our participants whether they are currently using age-adjusted cutoffs to rule out PE. I read one criticism of the Righini study whose author suggested the patients who were ruled out on the basis of the age-related cutoff were not confirmed as PE-negative using tomography. I would add that there is considerable variation in the way D-dimer results are reported, generating some confusion about reporting units and laboratory-generated cutoffs. The study reported variation in the outcomes based on the use of various D-dimer testing platforms. Nevertheless, if the age-related cutoff were judiciously applied, a number of patients could be spared the effort of tomography and perhaps unnecessary therapy.
Here is the JAMA report: joi140021