{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T03:19:12Z","timestamp":1793675952790,"version":"4.5.1"},"reference-count":29,"publisher":"American Medical Association (AMA)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA"],"published-print":{"date-parts":[[2026,2,3]]},"abstract":"\n Importance<\/jats:title>\n The age-adjusted D-dimer cutoff (age\u2009\u00d7\u200910 \u00b5g\/L in patients 50 years or older), safely increases the diagnostic yield of D-dimer in patients with suspected pulmonary embolism but has not been validated in patients with suspected leg deep vein thrombosis (DVT).<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To prospectively validate whether using an age-adjusted D-dimer cutoff allows clinicians to safely rule out DVT.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Patients<\/jats:title>\n Multicenter, multinational prospective management outcome study conducted in 27 centers in Belgium, Canada, France, and Switzerland between January 2015 and October 2022 (last follow-up visit, January 30, 2023) and including outpatients presenting to the emergency department with suspected DVT.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Patients were assessed by a sequential diagnostic strategy based on the assessment of clinical pretest probability by the Wells score, a highly sensitive D-dimer test, and leg compression ultrasonography. Patients in whom DVT was ruled out were followed up for a 3-month period.<\/jats:p>\n <\/jats:sec>\n \n Main Outcome and Measure<\/jats:title>\n The primary outcome was the rate of adjudicated symptomatic venous thromboembolic events during follow-up in patients in whom DVT was ruled out based on a D-dimer value between the conventional cutoff of 500 \u00b5g\/L and their age-adjusted cutoff.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n A total of 3205 patients were included. Median age was 59 years, and 1737 (54%) were female. DVT prevalence was 14%. Among the 2169 patients with a non-high or unlikely clinical probability, 531 (24.5% [95% CI, 22.7%-26.4%]) had a D-dimer level less than 500 \u00b5g\/L, and 161 additional patients (7.4% [95% CI, 6.4%-8.6%]) had a D-dimer level between 500 \u00b5g\/L and their age-adjusted cutoff. No failures were identified in patients with a D-dimer level 500 \u00b5g\/L or greater but below the age-adjusted cutoff (0% [95% CI, 0%-2.3%]). Among patients 75 years or older, using the age-adjusted cutoff instead of the 500-\u00b5g\/L cutoff increased the proportion of negative D-dimer from 33 of 379 (8.7% [95% CI, 6.3%-12.0%]) to 99 of 379 (26.1% [95% CI, 22.0%-30.8%]), without any false-negative test results.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n The age-adjusted D-dimer cutoff may safely rule out DVT and was associated with a larger number of patients in whom DVT could be effectively ruled out.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT02384135<\/jats:ext-link>\n .\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jama.2025.21561","type":"journal-article","created":{"date-parts":[[2026,1,5]],"date-time":"2026-01-05T16:00:31Z","timestamp":1767628831000},"page":"416","source":"Crossref","is-referenced-by-count":18,"title":["Age-Adjusted D-Dimer Cutoff Levels to Rule Out Deep Vein 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