J. van Es (1), I. Mos (2), R. Douma (1), P. Erkens (3, 4), M. Durian (5), T. Nizet (6), A. van Houten (7), H. Hofstee (8), H. ten Cate (9), E. Ullmann (6), H. Buller (1), M. Huisman (2), P. W. Kamphuisen (1)
(1) Academic Medical Center – Vascular Medicine, Amsterdam, Netherlands; (2) Leiden University Medical Center – General Internal Medicine – Endocrinology, Leiden, Netherlands; (3) Maastricht University Medical Center – Lab Clinical Thrombosis and Haemostasis, Cardiovascular Research Institute Maastricht, Maastricht, Netherlands; (4) Maastricht University Medical Center – Internal Medicine, Maastricht, Netherlands; (5) Erasmus University Medical Center – Hematology, Rotterdam, Netherlands; (6) Rijnstate Hospital – Pulmonary Medicine, Arnhem, Netherlands; (7) Maasstad Hospital – Internal and Pulmonal Medicine, Rotterdam, Netherlands; (8) VU University Medical Center – Internal Medicine, Amsterdam, Netherlands; (9) Department of Internal Medicine, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, the Netherlands
Four clinical decision rules (CDRs) (Wells score, Revised Geneva Score (RGS), simplified Wells score and simplified RGS) safely exclude pulmonary embolism (PE), when combined with a normal D-dimer test. Recently, an age-adjusted cut-off of the D-dimer (patient’s age x 10 μg/l) safely increased the number of patients above 50 years in whom PE could safely be excluded. We validated the age-adjusted D-dimer test and assessed its performance in combination with the four CDRs in patients with suspected PE. A total of 414 consecutive patients with suspected PE who were older than 50 years were included. The proportion of patients in whom PE could be excluded with an ‘unlikely’ clinical probability combined with a normal age-adjusted D-dimer test was calculated and compared with the proportion using the conventional D-dimer cut-off. We assessed venous thromboembolism (VTE) failure rates during three months follow-up. In patients above 50 years, a normal age-adjusted D-dimer level in combination with an ‘unlikely’ CDR substantially increased the number of patients in whom PE could be safely excluded: from 13–14% to 19–22% in all CDRs similarly. In patients over 70 years, the number of exclusions was nearly four-fold higher, and the original Wells score excluded most patients, with an increase from 6% to 21% combined with the conventional and age-adjusted D-dimer cut-off, respectively. The number of VTE failures was also comparable in all CDRs. In conclusion, irrespective of which CDR is used, the age-adjusted D-dimer substantially increases the number of patients above 50 years in whom PE can be safely excluded.
epidemiological studies, pulmonary embolism, clinical studies, aging
Nadine S. Gibson1, Maaike Sohne1, Marieke J. H. A. Kruip2, Lidwine W. Tick3, Victor E. Gerdes1, Patrick M. Bossuyt4, Philip S. Wells5, Harry R. Buller1 on behalf of the Christopher study investigators
Thromb Haemost 2008 99 1: 229-234
Robbert J. Goekoop1, Neeltje Steeghs1, Rene W. L. M. Niessen2, Gé J. P. M. Jonkers3, Hans Dik4,Ad Castel5, Lies Werker-van Gelder6, L. Tom Vlasveld6, Rik C. J. van Klink7, Erwin V. Planken8, Menno V. Huisman1
Thromb Haemost 2007 97 1: 146-150
B. M. Wolpin (1, 2), C. Kabrhel (3), R. Varraso (4, 5), P. Kraft (6), E. B. Rimm (6, 7, 8), S. Z. Goldhaber (9), C. A. Camargo, Jr. (3, 6, 8), C. S. Fuchs (1, 2, 8)
Thromb Haemost 2010 104 5: 962-971
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