What does this research mean for the field?

Using an age-adjusted D-dimer cutoff safely rules out deep vein thrombosis (DVT) in a larger proportion of patients, particularly those aged 75 and older, without increasing false-negative results. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 3, 2026Open Access

Age-Adjusted D-Dimer Cutoff Levels to Rule Out Deep Vein Thrombosis

Key Result

Using an age-adjusted D-dimer cutoff safely ruled out DVT in 7.4% more patients with no false negatives, increasing negative results to 26.1% in those ≥75 years.

Key Points

Using the age-adjusted d-dimer cutoff increased the number of patients safely ruled out for DVT without false negatives.
Among patients aged 75 and older, the age-adjusted cutoff raised the negative D-dimer detection rate from 8.7% to 26.1%.
This multicenter, multinational study assessed DVT diagnosis using a sequential strategy including clinical probability assessments.
Highlights the potential of age-adjusted d-dimer levels to improve DVT diagnostic pathways, warranting further clinical application.

Structured PICO

Does an age-adjusted D-dimer cutoff safely rule out DVT in outpatients presenting to the emergency department with suspected DVT?

Population

3,205 outpatients presenting to the emergency department with suspected deep vein thrombosis (DVT), median age 59 years, 54% female, multinational (Belgium, Canada, France, Switzerland).

Intervention

Sequential diagnostic strategy using an age-adjusted D-dimer cutoff (age × 10 µg/L for patients ≥50 years) along with clinical pretest probability (Wells score) and leg compression ultrasonography.

Comparator

Conventional D-dimer cutoff of 500 µg/L.

Outcome

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 µg/L and their age-adjusted cutoff.hard clinical

The age-adjusted D-dimer cutoff safely rules out DVT and increases the proportion of patients avoiding imaging, particularly among those aged 75 years or older.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Importance: The age-adjusted D-dimer cutoff (age × 10 µg/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). Objective: To prospectively validate whether using an age-adjusted D-dimer cutoff allows clinicians to safely rule out DVT. Design, setting, and patients: 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. Interventions: 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. Main outcome and measure: 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 µg/L and their age-adjusted cutoff. Results: A 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 µg/L, and 161 additional patients (7.4% 95% CI, 6.4%-8.6%) had a D-dimer level between 500 µg/L and their age-adjusted cutoff. No failures were identified in patients with a D-dimer level 500 µg/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-µg/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. Conclusions and relevance: 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. Trial registration: ClinicalTrials.gov Identifier: NCT02384135.