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Age-adjusted D-dimer to rule out deep vein thrombosis: findings from the PALLADIO algorithm
N Riva1, G Camporese2, M Iotti3
1University of Insubria, Varese, Italy.
Journal of Thrombosis and Haemostasis : JTH
|November 11, 2017
Summary
The age-adjusted D-dimer test, when used with the PALLADIO algorithm, slightly reduced the need for imaging in suspected venous thromboembolism (VTE). Further validation in large studies is recommended to confirm the safety of this approach for diagnosing deep vein thrombosis (DVT).
Area of Science:
- Medical diagnostics
- Thrombosis research
- Clinical decision-making
Background:
- The diagnostic accuracy of age-adjusted D-dimer for venous thromboembolism (VTE) is debated.
- Previous studies suggest age-adjusted D-dimer may improve specificity in VTE diagnosis.
- Recent findings question the reliability of the age-adjusted D-dimer threshold.
Purpose of the Study:
- To evaluate the diagnostic performance of age-adjusted D-dimer combined with clinical pretest probability (PTP) for suspected deep vein thrombosis (DVT).
- To assess the impact of age-adjusted D-dimer on the utilization of imaging tests within the PALLADIO algorithm.
Main Methods:
- Post-hoc analysis of the multicenter PALLADIO management study (NCT01412242) involving 1162 outpatients with suspected DVT.
- The PALLADIO algorithm incorporates PTP, D-dimer testing, and compression ultrasonography (CUS).
- Age-adjusted D-dimer cut-offs (age x 10 μg/L or age x 5 μg/L) were applied to patients >50 years.
Main Results:
- The age-adjusted D-dimer threshold reduced the need for CUS by 5.1% compared to a fixed cut-off.
- Deep vein thrombosis (DVT) was diagnosed in 4.0% of patients in group 2 and 53.0% in group 3 at initial visit.
- The incidence of symptomatic VTE during 3-month follow-up was low across all management groups.
Conclusions:
- The PALLADIO algorithm, utilizing age-adjusted D-dimer, demonstrated a modest decrease in imaging test requirements.
- The safety and efficacy of this age-adjusted D-dimer approach require confirmation in larger prospective management studies.
- This strategy may help optimize diagnostic pathways for suspected venous thromboembolism.
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