Age-Adjusted D-dimer for Venous Thromboembolism (VTE)
Adjusts D-dimer cutoffs to help rule out VTE in patients ≥50 years old.
Use in patients ≥50 years old presenting to emergency department as outpatients and are being worked up for PE with low to intermediate pretest probability. Do not use in high-risk patients (i.e., those who would proceed to imaging regardless of D-dimer result).
- The goals of the age-adjusted D-dimer is to increase the specificity of the test in patients ≥50 years old and prevent unnecessary testing and complications.
- Use of the age-adjusted D-dimer is not appropriate for patients who are high-risk based on clinical gestalt or clinical prediction scores, such as the Wells’ Criteria for PE (scores >4) or Revised Geneva Score (scores >11).
A patient with a D-dimer above the age-adjusted cutoff should undergo confirmatory testing with imaging (i.e., CTA, V/Q scan).
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No decision rule should trump clinical gestalt. High clinical suspicion for PE should warrant imaging regardless of risk score.
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Never delay resuscitative efforts for diagnostic testing, especially in the unstable patient.
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History and exam should always be performed prior to diagnostic testing.