Using Age-Adjusted D-Dimer Thresholds Improves Results of the Wells Rule for Ruling Out PE

The proportion of patients with suspected pulmonary embolism in whom imaging and anticoagulant therapy could be withheld safely increased from 28% to 33%.

Pulmonary embolism (PE) typically is ruled out when the Wells score is ≤4 and the d-dimer result is ≤500 µg/L. In this meta-analysis, researchers examined patient-level data from six prospective studies to compare the efficiency and safety of using the Wells rule with a fixed d-dimer threshold (500 µg/L) versus an age-adjusted threshold (age × 10 µg/L in patients older than 50) in 7298 patients with suspected PE. Imaging and anticoagulant therapy were withheld in patients with Wells scores ≤4 and negative d-dimer results at initial evaluation. All patients were followed for 3 months.

When the fixed d-dimer threshold was used, PE was ruled out in 28% of patients; the failure rate (i.e., the proportion of patients with symptomatic deep venous …

Reviewing Author

Jamaluddin Moloo, MD, MPH

Disclosures

Grant / Research supportColorado Health Foundation

Jamaluddin Moloo, MD, MPH

Disclosures

Grant / Research supportColorado Health Foundation

Using Age-Adjusted D-Dimer Thresholds Improves Results of the Wells Rule for Ruling Out PE

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Reviewing Author