The conventional D-dimer cutoff of 500 µg/L is widely used to exclude venous thromboembolism but has reduced specificity in older patients. Although an age-adjusted D-dimer cutoff (age × 10 µg/L in patients aged 50 years or older) has been validated for suspected pulmonary embolism, its safety and effectiveness in patients with suspected lower-limb deep vein thrombosis (DVT) had not been prospectively established.

We reviewed a recent study by Le Gal et al (JAMA Online, 5 January 2026) that validated whether an age-adjusted D-dimer cutoff could safely be used to rule out DVT in routine clinical practice. Their key findings are summarized below. 

The multicentre, multinational, prospective management outcome study enrolled outpatients presenting to emergency departments with suspected DVT from 27 centres across Belgium, Canada, France, and Switzerland between January 2015 and October 2022. Patients were evaluated using a predefined sequential diagnostic strategy that included assessment of clinical pretest probability with the Wells score, a highly sensitive D-dimer assay, and leg compression ultrasonography. Patients in whom DVT was ruled out were followed for three months.

The primary outcome was the rate of adjudicated symptomatic venous thromboembolic events during follow-up in patients whose DVT was excluded based on a D-dimer value between the conventional cutoff of 500 µg/L and their age-adjusted cutoff.

A total of 3,205 patients were included (median age 59 years; 54% female), with an overall DVT prevalence of 14%. Among patients with a non-high or unlikely clinical probability, 24.5% had a D-dimer level below 500 µg/L, while an additional 7.4% had a D-dimer level between 500 µg/L and their age-adjusted cutoff. Use of the age-adjusted cutoff increased the proportion of patients with a negative D-dimer result, with particularly striking results in patients aged 75 years or older, where the proportion increased from 8.7% to 26.1%.

No adjudicated symptomatic venous thromboembolic events occurred during follow-up in patients whose DVT was excluded using a D-dimer value between 500 µg/L and the age-adjusted cutoff.

These findings demonstrate that an age-adjusted D-dimer cutoff may safely rule out DVT and increase the proportion of patients in whom DVT can be excluded without imaging (ClinicalTrials.gov Identifier: NCT02384135).

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