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Niveles de corte de D-dimer ajustados por edad para descartar la trombosis venosa profunda
Grégoire Le Gal1,2, Helia Robert-Ebadi3, Venkatesh Thiruganasambandamoorthy1,4
1Ottawa Health Research Institute, Ottawa, Ontario, Canada.
JAMA
|January 6, 2026
Resumen
El corte de D-dimero ajustado por edad descarta con seguridad la trombosis venosa profunda (TVP) en pacientes con sospecha de TVP en las piernas. Este método aumenta el número de pacientes que pueden ser efectivamente descartados para la TVP, especialmente los adultos mayores.
Área de la Ciencia:
- Medicina vascular
- Imágenes de diagnóstico
- Patología clínica
Sus antecedentes:
- El corte convencional de D-dimero para el diagnóstico de la trombosis venosa profunda (TVP) tiene limitaciones, especialmente en adultos mayores.
- Un corte de D-dimero ajustado por edad ha demostrado ser prometedor para aumentar el rendimiento diagnóstico de la embolia pulmonar, pero requiere validación para la TVP en las piernas.
Objetivo del estudio:
- Validar prospectivamente la seguridad y eficacia de un corte de D-dimero ajustado por edad para descartar la sospecha de trombosis venosa profunda en las piernas (TVP).
Principales métodos:
- Un estudio prospectivo multinacional y multicéntrico en el que participaron 3205 pacientes ambulatorios con sospecha de TVP.
- Los pacientes fueron evaluados utilizando la puntuación de Wells, una prueba de D-dimero sensible y una ecografía de piernas.
- Los pacientes con TVP descartada fueron seguidos durante 3 meses para controlar los eventos tromboembólicos venosos.
Principales resultados:
- No se produjeron fallos diagnósticos de TVP en pacientes con niveles de D-dimero entre 500 μg/ L y su límite ajustado por edad.
- En pacientes de 75 años o más, el límite ajustado por edad aumentó la proporción de resultados negativos de D-dimero del 8,7% al 26,1% sin falsos negativos.
- El límite ajustado por edad permitió descartar con seguridad la TVP a más pacientes.
Conclusiones:
- El corte de D-dimero ajustado por edad es una herramienta segura y efectiva para descartar la trombosis venosa profunda (TVP) en pacientes con sospecha de TVP en las piernas.
- Este enfoque mejora la eficiencia del diagnóstico al aumentar el número de pacientes que pueden ser excluidos con confianza de tener TVP, especialmente en las poblaciones de edad avanzada.
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