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The combination of four different clinical decision rules and an age-adjusted D-dimer cut-off increases the number of patients in whom acute pulmonary embolism can safely be excluded.
Thromb Haemost. 2012 Jan; 107(1):167-71.TH

Abstract

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.

Authors+Show Affiliations

Vascular Medicine, Amsterdam Medical Center, AMC F4-142 Meibergdreef 9, 1105 AZ Amsterdam, Netherlands. j.vanes@amc.uva.nlNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22072293

Citation

van Es, Josien, et al. "The Combination of Four Different Clinical Decision Rules and an Age-adjusted D-dimer Cut-off Increases the Number of Patients in Whom Acute Pulmonary Embolism Can Safely Be Excluded." Thrombosis and Haemostasis, vol. 107, no. 1, 2012, pp. 167-71.
van Es J, Mos I, Douma R, et al. The combination of four different clinical decision rules and an age-adjusted D-dimer cut-off increases the number of patients in whom acute pulmonary embolism can safely be excluded. Thromb Haemost. 2012;107(1):167-71.
van Es, J., Mos, I., Douma, R., Erkens, P., Durian, M., Nizet, T., van Houten, A., Hofstee, H., ten Cate, H., Ullmann, E., Büller, H., Huisman, M., & Kamphuisen, P. W. (2012). The combination of four different clinical decision rules and an age-adjusted D-dimer cut-off increases the number of patients in whom acute pulmonary embolism can safely be excluded. Thrombosis and Haemostasis, 107(1), 167-71. https://doi.org/10.1160/TH11-08-0587
van Es J, et al. The Combination of Four Different Clinical Decision Rules and an Age-adjusted D-dimer Cut-off Increases the Number of Patients in Whom Acute Pulmonary Embolism Can Safely Be Excluded. Thromb Haemost. 2012;107(1):167-71. PubMed PMID: 22072293.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The combination of four different clinical decision rules and an age-adjusted D-dimer cut-off increases the number of patients in whom acute pulmonary embolism can safely be excluded. AU - van Es,Josien, AU - Mos,Inge, AU - Douma,Renée, AU - Erkens,Petra, AU - Durian,Marc, AU - Nizet,Tessa, AU - van Houten,Anja, AU - Hofstee,Herman, AU - ten Cate,Hugo, AU - Ullmann,Eric, AU - Büller,Harry, AU - Huisman,Menno, AU - Kamphuisen,P W, Y1 - 2011/11/10/ PY - 2011/08/25/received PY - 2011/10/06/accepted PY - 2011/11/11/entrez PY - 2011/11/11/pubmed PY - 2012/5/26/medline SP - 167 EP - 71 JF - Thrombosis and haemostasis JO - Thromb Haemost VL - 107 IS - 1 N2 - 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. SN - 2567-689X UR - https://www.unboundmedicine.com/medline/citation/22072293/The_combination_of_four_different_clinical_decision_rules_and_an_age_adjusted_D_dimer_cut_off_increases_the_number_of_patients_in_whom_acute_pulmonary_embolism_can_safely_be_excluded_ L2 - http://www.thieme-connect.com/DOI/DOI?10.1160/TH11-08-0587 DB - PRIME DP - Unbound Medicine ER -