Does age-adjusted D-Dimer have a role in assessment of VTE recurrence rates?

It is known that D-dimer levels increase with age and several studies have evaluated the use of an age-adjusted (AA) cut-off in the initial assessment of suspected venous thromboembolism (VTE). We performed a retrospective study to assess the effect that using an AA D-dimer in the DASH score would have on the recommended duration of anticoagulant treatment for patients following a first unprovoked episode of VTE and then compared this with the advice that has been given to patients using a fixed cut-off D-dimer in the DASH score.

Data were collected for the period from April 2014 to October 2017. For each patient, the DASH score by a single cut-off D-dimer value (500 ng/mL) as well as an AA D-dimer cut-off value (D-dimer cut-off value equal to age in years × 10) was calculated for patients over 50 years. The Vienna prediction model was employed alongside this to compare the VTE recurrence risk using a well-established method.

A total of 204 patients were eligible for analysis, 145 of whom were over the age of 50 years. In 24 of these patients, the use of the AA D-dimer made a significant impact on the predicted risk of recurrence using the DASH score and would have likely changed the recommendation to offer long-term anticoagulation.

As an age-adjusted D-dimer cut-off has been assessed in the diagnostic setting, it would be logical and appropriate to also consider this philosophy in the prediction of the risk of recurrence of VTE following a first unprovoked event.