Please use this identifier to cite or link to this item: https://www.um.edu.mt/library/oar/handle/123456789/88445
Title: Age-adjusted D-dimer to rule out deep vein thrombosis : findings from the PALLADIO algorithm
Authors: Riva, Nicoletta
Camporese, Giuseppe
Iotti, Matteo
Bucherini, Eugenio
Righini, Marc
Kamphuisen, Pieter W.
Verhamme, Peter
Douketis, James D.
Tonello, Chiara
Prandoni, Paolo
Ageno, Walter
Keywords: Biochemical markers
Thromboembolism
Issue Date: 2018
Publisher: International Society on Thrombosis and Haemostasis
Citation: Riva, N., Camporese, G., Iotti, M., Bucherini, E., Righini, M., Kamphuisen, P. W., ... & Donadini, M. (2018). Age‐adjusted D‐dimer to rule out deep vein thrombosis: findings from the PALLADIO algorithm. Journal of Thrombosis and Haemostasis, 16(2), 271-278.
Abstract: Summary: Background Age-adjusted D-dimer has been proposed to increase specificity for the diagnosis of venous thromboembolism (VTE). However, the accuracy of this threshold has been recently questioned. Objectives To assess the diagnostic performance of age-adjusted D-dimer combined with clinical pretest probability (PTP) in patients with suspected deep vein thrombosis (DVT). Methods PALLADIO (NCT01412242) was a multicenter management study that validated a new diagnostic algorithm, incorporating PTP, D-dimer (using the manufacturer's cut-off) and limited or extended compression ultrasonography (CUS) in outpatients with clinically suspected DVT. Patients with unlikely PTP and negative D-dimer had DVT ruled out without further testing (group 1); patients with likely PTP or positive D-dimer underwent limited CUS (group 2); patients with likely PTP and positive D-dimer underwent extended CUS (group 3). Patients with DVT ruled out at baseline had a 3-month follow-up. In this post-hoc analysis we evaluated age-adjusted D-dimer cut-off (defined as age times 10 μg L-1 , or age times 5 μg L-1 for D-dimers with a lower manufacturer's cut-off, in patients > 50 years). Results In total, 1162 patients were enrolled. At initial visit, DVT was detected in 4.0% of patients in group 2 and 53.0% in group 3. The age-adjusted D-dimer, compared with the fixed cut-off, resulted in 5.1% (95% CI, 4.0-6.5%) reduction of CUS. The incidence of symptomatic VTE during follow-up was: 0.24% (95% CI, 0.04-1.37) in group 1; 1.12% (95% CI, 0.44-2.85) in group 2; and 1.89% (95% CI, 0.64-5.40) in group 3. Conclusions The PALLADIO algorithm using age-adjusted D-dimer slightly decreased the number of required imaging tests, but this approach should be confirmed in large management studies
URI: https://www.um.edu.mt/library/oar/handle/123456789/88445
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