D-Dimer Cutoffs in Bedridden Hospitalized Elderly Patients

“

Deep vein thrombosis (DVT) and its possible life-threatening consequence, pulmonary embolism (PE), are leading causes of preventable morbidity and mortality following the hospitalization of elderly people. Accurate and timely diagnosis of venous thromboembolism (VTE) can be lifesaving especially in this age-group due to short-term mortality. However, in bedridden elderly patients, the diagnosis of DVT may be challenging because of the high prevalence of asymptomatic cases. Nowadays, the diagnostic workup for suspected VTE has evolved into an integrated approach that includes pretest probability (PTP) assessment and D-dimer testing in combination with imaging. D-Dimer assay is the best recognized biomarker for the initial assessment of suspected VTE due to high sensitivity in comparison with poor specificity; false-positive D-dimer results have been noted in inflammation, pregnancy, malignancy, and the elderly individuals. A high proportion of elderly patients with a non-high clinical probability undergo unnecessary burdensome diagnostic investigations, in whom the yield of this imaging is relatively low. Hence, D-dimer tests are often used to rule out VTE (PE or DVT) in these patients in contrast to those with a high clinical probability in whom imaging examination is warranted to confirm or refute the diagnosis irrespective of the D-dimer results

”