The age-adjusted D-dimer cutoff may safely rule out suspected leg deep vein thrombosis (DVT), according to the multicenter, multinational ADJUST-DVT study published Jan. 5 in JAMA. D-dimer was associated with ruling out DVT in a larger number of patients.

This prospective management outcome study included 3,205 patients across 27 centers in Belgium, Canada, France and Switzerland. The study included patients presenting to the emergency department with suspected DVT between January 2015 and October 2022. Patients had a median age of 59 years and 54% were female.

Grégoire Le Gal, MD, PhD, et al., assessed patients with a sequential diagnostic strategy using the Wells score, a highly sensitive D-dimer test, and leg compression ultrasonography. All patients in whom DVT was ruled out were then followed for three months.

The primary endpoint was the rate of adjudicated symptomatic venous thromboembolic events (VTE) during follow-up based on a D-dimer value between the conventional cutoff (500 μg/L) and the age-adjusted cutoff (age x 10 μg/L or patients ≥50 years old).

Of the 2,169 patients with a clinical probability of DVT that was not high or likely, the D-dimer level was <500 μg/L in 531 patients (25%), while 161 patients (7%) had a D-dimer level between 500 μg/L and their age-adjusted cutoff, none of whom had a VTE at three months.

In patients ≥75 years, using the age-adjusted cutoff increased the proportion of negative D-dimer from 33 of 379 (9%) to 99 of 379 (26%) and no false-negative test results were reported. A 7.4% absolute increase in patients in whom DVT could be excluded was observed with the age-adjusted cutoff.

Le Gal and colleagues note their study "supports the consistent use of the age-adjusted cutoff in patients with suspected pulmonary embolism and those with suspected leg DVT." Furthermore, they write, "The age-adjusted cutoff significantly increases the proportion of patients in whom DVT can be excluded without the need for leg compression ultrasonography.

In an accompanying editorial comment, Francisco Ujueta, MD, BS, MS, FACC, and Gregory Piazza, MD, FACC, note that "...the implications of ADJUST-DVT have the potential to align the principles of precision medicine with efficiency, patient safety and value-based care." They believe that ADJUST-DVT "...provides a fertile foundation for future clinical studies and real-world integration in appropriately selected patient care settings."