#3-30E. Optimizing DVT Diagnosis: The Safety of Age-Adjusted D-Dimer Cutoffs (JAMA, 2026)

Deep vein thrombosis (DVT) diagnosis in older adults presents a frequent clinical challenge, where the reduced specificity of D-dimer testing often necessitates unnecessary ultrasound imaging. Addressing this efficiency gap, the ADJUST-DVT study prospectively validated the safety of an age-adjusted D-dimer cutoff (defined as age × 10 _μ_g/L) in outpatients aged 50 years or older. The results were compelling; among patients whose D-dimer levels fell between the conventional 500 _μ_g/L threshold and their calculated age-adjusted cutoff, the 3-month rate of venous thromboembolism was 0%. This adjustment safely increased the proportion of patients in whom DVT could be ruled out without imaging by an absolute 7.4%, significantly impacting resource utilization. However, critical appraisal requires noting that the study aggregated data across 11 different commercial D-dimer assays, a variable that suggests a need for caution regarding assay standardization. Nevertheless, for emergency and primary care physicians, this study provides robust evidence to confidently implement age-adjusted cutoffs, streamlining the diagnostic workup for elderly patients while maintaining rigorous safety standards.

Citation: Le Gal, G. et al. Age-Adjusted D-Dimer Cutoff Levels to Rule Out Deep Vein Thrombosis. JAMA. 2026. DOI: 10.1001/jama.2025.21561

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