Age‐adjusted D‐dimer to rule out deep vein thrombosis: findings from the PALLADIO algorithm
| العنوان: | Age‐adjusted D‐dimer to rule out deep vein thrombosis: findings from the PALLADIO algorithm |
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| المؤلفون: | N. Riva, G. Camporese, M. Iotti, E. Bucherini, M. Righini, P.W. Kamphuisen, P. Verhamme, J.D. Douketis, C. Tonello, P. Prandoni, W. Ageno, A. Ghirarduzzi, M.R. Veropalumbo, M. Donadini |
| المساهمون: | Cardiovascular Centre (CVC) |
| المصدر: | Journal of Thrombosis and Haemostasis, Vol. 16, No 2 (2018) pp. 271-278 Journal of Thrombosis and Haemostasis, 16(2), 271-278. Wiley |
| بيانات النشر: | Elsevier BV, 2018. |
| سنة النشر: | 2018 |
| مصطلحات موضوعية: | Male, Databases, Factual, diagnosis, Deep vein, MULTICENTER, 030204 cardiovascular system & hematology, 0302 clinical medicine, Risk Factors, EXCLUSION, Prevalence, 030212 general & internal medicine, Ultrasonography, Aged, 80 and over, Venous Thrombosis, ddc:616, Incidence, Incidence (epidemiology), Age Factors, Venous Thromboembolism, Hematology, Middle Aged, Thrombosis, Pulmonary embolism, Venous thrombosis, medicine.anatomical_structure, Female, Algorithm, Algorithms, Adult, PULMONARY-EMBOLISM, Clinical Decision-Making, Age adjustment, Unnecessary Procedures, Decision Support Techniques, Fibrin Fibrinogen Degradation Products, 03 medical and health sciences, Predictive Value of Tests, D-dimer, MANAGEMENT, medicine, Humans, INDIVIDUAL-PATIENT DATA, Aged, WELLS RULE, business.industry, Reproducibility of Results, Emergency department, PERFORMANCE, algorithms, outpatients, ultrasonography, venous thrombosis, medicine.disease, EMERGENCY-DEPARTMENT, business, Biomarkers |
| الوصف: | Background Age-adjusted D-dimer has been proposed to increase specificity for the diagnosis of venous thromboembolism (VTE). However, the accuracy of this threshold has been recently questioned. Objectives To assess the diagnostic performance of age-adjusted D-dimer combined with clinical pre-test probability (PTP) in patients with suspected deep vein thrombosis (DVT). Methods PALLADIO (NCT01412242) was a multicentre management study that validated a new diagnostic algorithm, incorporating PTP, D-dimer (using manufacturers’ cut-off), and limited or extended compression ultrasonography (CUS) in outpatients with clinically suspected DVT. Patients with unlikely PTP and negative D-dimer had DVT ruled out without further testing (group 1); patients with likely PTP or positive D-dimer underwent limited-CUS (group 2); patients with likely PTP and positive D-dimer underwent extended-CUS (group 3). Patients with DVT ruled out at baseline had a 3-month follow-up. In this post-hoc analysis we evaluated age-adjusted D-dimer cut-off (defined as age times 10μg/L, or age times 5μg/L for D-dimers with lower manufacturers’ cut-off, in patients >50 years). Results 1162 patients were enrolled. At initial visit, DVT were detected in 4.0% of patients in group 2 and 53.0% in group 3. The age-adjusted D-dimer, compared to the fixed cut-off, resulted in 5.1% (95%CI, 4.0-6.5%) reduction of CUS. The incidence of symptomatic VTE during follow-up was: 0.24% (95%CI, 0.04-1.37) in group 1; 1.12% (95%CI, 0.44-2.85) in group 2; 1.89% (95%CI, 0.64-5.40) in group 3. Conclusions The PALLADIO algorithm using age-adjusted D-dimer slightly decreased the number of required imaging tests, but this approach should be confirmed in large management studies. This article is protected by copyright. All rights reserved. |
| وصف الملف: | application/pdf |
| تدمد: | 1538-7836 1538-7933 |
| الوصول الحر: | https://explore.openaire.eu/search/publication?articleId=doi_dedup___::d09eceffd9812324a438acf0255cef56Test https://doi.org/10.1111/jth.13905Test |
| حقوق: | OPEN |
| رقم الانضمام: | edsair.doi.dedup.....d09eceffd9812324a438acf0255cef56 |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15387836 15387933 |
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