Righini M, et al. Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism: The ADJUST-PE Study. JAMA (4)

摘要

A D-dimer concentration less than 500 μg/L has been shown to accurately exclude pulmonary embolism (PE) in patients with a low probability of venous thromboembolism (VTE). Retrospective data have shown that D-dimer levels increase with age, and that an age-adjusted D-dimer cutoff could exclude PE in patients over age 50 years. The ADJUST-PE Study was designed as a prospective validation of this age-adjusted D-dimer cutoff. This multicenter, multinational study enrolled 3,324 patients who presented to an emergency department with suspected acute PE and a calculated creatinine clearance greater than 30 ml/min. The clinical probability of PE was assessed with either a revised Geneva score or a two-level Wells score. Patients with a high (Geneva) or likely (Wells) probability were assessed with computed tomography pulmonary angiography. Those with a low/intermediate (Geneva) or unlikely (Wells) score underwent D-dimer testing. The cutoff for patients under age 50 years was 500 μg/L. For those aged 50 years or older, it was their age multiplied by 10. Patients with a D-dimer level below the age-adjusted cutoff received no further VTE-directed testing, and were not anticoagulated. Those with a level above the cutoff underwent computed tomography pulmonary angiography.