Will the use of a raised or age-adjusted D-dimer cut-off value in combination with a sequential strategy using the Wells score safely exclude deep venous thrombosis?

The reference interval for D-dimer is increasing with age, making a fixed cut-off value for venous thromboembolism (VTE) less appropriate, as the number of VTE increases with age. We aimed to test whether a raised (0.9 FEU/L) or age-related (0.01*age FEU/L in age >50 years) D-dimer cut-off limit safely excludes deep venous thrombosis (DVT) after a risk estimation using Wells score in a population admitted to an emergency department with a suspicion of (DVT). D-dimer should be used to rule out DVT in groups with intermediate or low pre-test probability of DVT using the Wells score.