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

Intern Emerg Med. 2013 Apr;8(3):229-36. doi: 10.1007/s11739-011-0608-5. Epub 2011 May 17.


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.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Age Factors
  • Aged
  • Aged, 80 and over
  • Female
  • Fibrin Fibrinogen Degradation Products / metabolism*
  • Fibrinolytic Agents
  • Humans
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Sex Factors
  • Venous Thromboembolism / blood*
  • Venous Thromboembolism / drug therapy
  • Venous Thromboembolism / etiology*
  • Vitamin K / antagonists & inhibitors
  • Young Adult


  • Fibrin Fibrinogen Degradation Products
  • Fibrinolytic Agents
  • fibrin fragment D
  • Vitamin K