Age and gender specific cut-off values to improve the performance of d-dimer assays to predict the risk of venous thromboembolism recurrence

Cristina Legnani, Michela Cini, Benilde Cosmi, Paolo Carraro, Armando Tripodi, Nicoletta Erba, Gualtiero Palareti

Research output: Contribution to journalArticle

Abstract

The Prolong study shows that continuing vitamin K antagonists (VKA) in patients with abnormal d-dimer (evaluated by a qualitative assay, Clearview Simplify d-dimer) results in a significant reduction of venous thromboembolism (VTE) recurrence. The present study retrospectively analyzes a subgroup of patients enrolled in the Prolong study with a view to calculate cut-off values for six quantitative d-dimer methods to predict the risk of VTE recurrence. We measured d-dimer levels by VIDAS d-dimer Exclusion (bioMerieux), STA Liatest d-dimer (DiagnosticaStago), HemosIL d-dimer and HemosIL d-dimer HS (Instrumentation Laboratory), Innovance d-dimer (Siemens) and AutoDimer (Trinity Biotech) in frozen plasma aliquots sampled 30 ± 10 days after VKA cessation in 390 patients enrolled in the Prolong study. During follow-up (562. 7 years), 28 patients had recurrent VTE (7. 2%, 5. 0% person-years). Since d-dimer levels are positively correlated with age and significantly lower in men, we calculated method-specific cut-off values according to age and gender. The HRs for VTE recurrence calculated using method-specific cut-off values based on age and gender are higher than those using cut-off values indicated by the manufacturers for VTE exclusion in symptomatic outpatients. These data suggest that method-specific cut-off values calculated according to patient age and gender can be more accurate in identifying patients at a higher risk for VTE recurrence. These method-specific cut-off values are being evaluated in the ongoing prospective management multicenter DULCIS study.

Original languageEnglish
Pages (from-to)229-236
Number of pages8
JournalInternal and Emergency Medicine
Volume8
Issue number3
DOIs
Publication statusPublished - 2013

Keywords

  • Anticoagulation
  • d-dimer
  • Recurrence
  • Risk factors
  • Venous thromboembolism

ASJC Scopus subject areas

  • Emergency Medicine
  • Internal Medicine

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