{"id":30165,"date":"2026-04-14T04:11:00","date_gmt":"2026-04-13T20:11:00","guid":{"rendered":"https:\/\/csccm.org.cn\/?p=30165"},"modified":"2026-04-14T05:55:01","modified_gmt":"2026-04-13T21:55:01","slug":"jama%e5%8f%91%e5%b8%83%e8%ae%ba%e6%96%87%ef%bc%9a%e5%b9%b4%e9%be%84%e6%a0%a1%e6%ad%a3d-%e4%ba%8c%e8%81%9a%e4%bd%93%e4%b8%b4%e7%95%8c%e5%80%bc%e4%bb%a5%e6%8e%92%e9%99%a4%e8%82%be%e9%9d%99%e8%84%89","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=30165","title":{"rendered":"[JAMA\u53d1\u5e03\u8bba\u6587]\uff1a\u5e74\u9f84\u6821\u6b63D-\u4e8c\u805a\u4f53\u4e34\u754c\u503c\u4ee5\u6392\u9664\u80be\u9759\u8109\u8840\u6813\u5f62\u6210"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Age-Adjusted D-Dimer Cutoff Levels to Rule Out Deep Vein Thrombosis<\/h1>\n\n\n\n

Gr\u00e9goire Le Gal, Helia Robert-Ebadi, Venkatesh Thiruganasambandamoorthy, et al<\/h3>\n\n\n\n

JAMA 2026;335;(5):416-424. doi:10.1001\/jama.2025.21561<\/h3>\n\n\n\n

Key Points<\/p>\n\n\n\n

Question<\/strong>  Does an age-adjusted D-dimer cutoff safely increase the proportion of patients in whom deep vein thrombosis (DVT) can be excluded?<\/p>\n\n\n\n

Findings<\/strong>  In this multinational prospective outcome study including 3205 outpatients presenting to the emergency department with suspected DVT, the age-adjusted D-dimer cutoff safely excluded DVT. Among patients with D-dimer level between 500 \u00b5g\/L and their age-adjusted cutoff, none developed venous thromboembolism at 3 months. Use of the age-adjusted cutoff resulted in a 7.4% absolute increase in the proportion of patients in whom the diagnosis could be excluded.<\/p>\n\n\n\n

Meaning<\/strong>  An age-adjusted D-dimer cutoff may safely rule out DVT and increase diagnostic efficiency, reducing the need for unnecessary imaging.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  The age-adjusted D-dimer cutoff (age\u2009\u00d7\u200910 \u00b5g\/L in patients 50 years or older), safely increases the diagnostic yield of D-dimer in patients with suspected pulmonary embolism but has not been validated in patients with suspected leg deep vein thrombosis (DVT).<\/p>\n\n\n\n

Objective<\/strong>  To prospectively validate whether using an age-adjusted D-dimer cutoff allows clinicians to safely rule out DVT.<\/p>\n\n\n\n

Design, Setting, and Patients<\/strong>  Multicenter, multinational prospective management outcome study conducted in 27 centers in Belgium, Canada, France, and Switzerland between January 2015 and October 2022 (last follow-up visit, January 30, 2023) and including outpatients presenting to the emergency department with suspected DVT.<\/p>\n\n\n\n

Interventions<\/strong>  Patients were assessed by a sequential diagnostic strategy based on the assessment of clinical pretest probability by the Wells score, a highly sensitive D-dimer test, and leg compression ultrasonography. Patients in whom DVT was ruled out were followed up for a 3-month period.<\/p>\n\n\n\n

Main Outcome and Measure<\/strong>  The primary outcome was the rate of adjudicated symptomatic venous thromboembolic events during follow-up in patients in whom DVT was ruled out based on a D-dimer value between the conventional cutoff of 500 \u00b5g\/L and their age-adjusted cutoff.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0A total of 3205 patients were included. Median age was 59 years, and 1737 (54%) were female. DVT prevalence was 14%. Among the 2169 patients with a non-high or unlikely clinical probability, 531 (24.5% [95% CI, 22.7%-26.4%]) had a D-dimer level less than 500 \u00b5g\/L, and 161 additional patients (7.4% [95% CI, 6.4%-8.6%]) had a D-dimer level between 500 \u00b5g\/L and their age-adjusted cutoff. No failures were identified in patients with a D-dimer level 500 \u00b5g\/L or greater but below the age-adjusted cutoff (0% [95% CI, 0%-2.3%]). Among patients 75 years or older, using the age-adjusted cutoff instead of the 500-\u00b5g\/L cutoff increased the proportion of negative D-dimer from 33 of 379 (8.7% [95% CI, 6.3%-12.0%]) to 99 of 379 (26.1% [95% CI, 22.0%-30.8%]), without any false-negative test results.<\/p>\n\n\n\n

\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n
\"\"\/<\/figure>\n\n\n\n

Conclusions and Relevance<\/strong>  The age-adjusted D-dimer cutoff may safely rule out DVT and was associated with a larger number of patients in whom DVT could be effectively ruled out.<\/p>\n\n\n\n

Trial Registration<\/strong>  ClinicalTrials.gov Identifier: NCT02384135<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Age-Adjusted D-Dimer Cutof […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30165"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=30165"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30165\/revisions"}],"predecessor-version":[{"id":30563,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/30165\/revisions\/30563"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=30165"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=30165"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=30165"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}