Can I use the age adjusted D-dimer in clinical practice? If so, how?
The ADJUST PE trial is hot off the JAMA presses in March 2014.
The takehome: of 1141 patients excluded from scanning by clinical assessment plus age adjusted d-dimer, there were only 2 cases of non-fatal PE (0.2%). Of these 1141 patients, 331 had an age adjusted d-dimer greater than the standard cutoff of 500mg/mL. Of these 331, only one had a confirmed case of PE in the following 3 months.
Is it ready to become “standard practice?” No, it still needs validation studies in our US populations. If you use this study to support clinical practice, be prepared to discuss its limitations with the patient, explain that its validation population is European, and that it is not part of standard US practice. Otherwise, have at it.
How do I use it? From UpToDate: “Those who were PE unlikely underwent appropriate age-adjusted D-dimer testing (age multiplied by 10 [eg, normal D-dimer at 60 years is <600 mg/mL]). When the age-adjusted value was negative, no further testing was performed.”
Read the article: http://www.ncbi.nlm.nih.gov/pubmed/24643601 Righini et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA. 2014 Mar 19;311(11):1117-24