Age adjusted D-dimer (AADD)

D-dimer is a fibrin degradation product, which has a high negative predictive value for pulmonary embolism (1)

• D-dimer values increase with advancing age, leading to a decreased specificity and therefore a reduced ability to exclude PE in older adults
• to increase the clinical usefulness of D-dimer, a cutoff adjusted to patient’s age was developed
  • age-adjusted D-dimer (AADD) cutoff consists of a cutoff <500 µg/L up to 50 years of age and a cutoff <(age × 10) µg/L in patients >50 years of age

AADD and diagnosis of PE

• with respect to the diagnostic accuracy for PE, a large prospective multinational management outcome study proved the safety of the AADD cutoff (2)

ADDD and diagnosis of deep vein thrombisis (DVT)

• with respect to diagnosis of DVT, the specificity of the D-dimer test decreases with age, leading to a reduced clinical usefulness in older adult patients
• in a multinational prospective outcome study including 3205 outpatients presenting to the emergency department with suspected DVT, the age-adjusted D-dimer cutoff safely excluded DVT (3)
  • among patients with D-dimer level between 500 µg/L and their age-adjusted cutoff, none developed venous thromboembolism at 3 months
  • use of the age-adjusted cutoff resulted in a 7.4% absolute increase in the proportion of patients in whom the diagnosis could be excluded
  • study authors concluded:
    • that an age-adjusted D-dimer cutoff may safely rule out DVT and increase diagnostic efficiency, reducing the need for unnecessary imaging

Reference:

1. Dutton J, Dachsel M, Crane R. Can the use of an age-adjusted D-dimer cut-off value help in our diagnosis of suspected pulmonary embolism?. Clin Med (Lond). 2018 Aug;18(4):293-296.
2. Righini M et al. Age-adjusted D-dimer cutoff levels to rule out pulmonary embolism: the ADJUST-PE study. JAMA. 2014 Mar 19;311(11):1117-24.
3. Le Gal G, Robert-Ebadi H, Thiruganasambandamoorthy V, et al. Age-Adjusted D-Dimer Cutoff Levels to Rule Out Deep Vein Thrombosis. JAMA. Published online January 05, 2026.