Background: For patients with suspected pulmonary embolism (PE), age- or clinically-adjusted D-dimer threshold level can be used to define a negative test that safely exclude PE and reduce the use of chest imaging. However, the utility of this approach in patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbation is undefined.
Aims: To assess the clinical usefulness and diagnostic accuracy of the age- and clinical probability-adjusted strategies of D-dimer interpretation, compared with the conventional fixed threshold, in patients hospitalized for exacerbations of COPD.
Methods: We run a post hoc analysis of the patients who required hospitalization for exacerbation of COPD and were randomized to the intervention arm in the SLICE trial. Using the conventional fixed strategy as the reference, we compared the proportion of patients with a negative D-dimer result, and the negative predictive value and sensitivity of three D-dimer threshold strategies for initial PE or subsequent diagnosis of venous thromboembolism (VTE): the age-adjusted strategy, the Wells-adjusted strategy, and the YEARS-adjusted strategy.
Results: A total of 368 patients were included. Using a conventional threshold, 182 (49.5%) patients had negative D-dimer values, of whom 1 (0.6%) had PE diagnosed during the initial work-up (sensitivity, 94.1%). The use of an age-adjusted threshold increased the number of patients in whom PE could be excluded from 182 to 233 patients (63.3%), and the proportion of false-negative findings increased to 1.7% (sensitivity, 76.5%). With the use of a D-dimer threshold based on the Wells score or YEARS criteria, 64.4% and 71.5% had negative values, and the proportion of false-negative findings was 2.5% (sensitivity, 64.7%) and 2.7% (sensitivity, 58.8%), respectively.
Conclusion(s): In patients hospitalized for COPD exacerbation, compared with the conventional fixed strategy, age- or clinically-adjusted strategies of D-dimer interpretation were associated with a larger proportion of patients in whom PE could be considered ruled out with a higher failure rate.
To cite this abstract in AMA style:Jimenez D, Rodriguez C, Jara-Palomares L, Tabernero E, Tenes A, Gonzalez S, Briceño W, Lobo J, Morillo R, Bikdeli B. Adjusted D-dimer cutoff levels to rule out pulmonary embolism in patients hospitalized for COPD exacerbation: results from the SLICE trial [abstract]. https://abstracts.isth.org/abstract/adjusted-d-dimer-cutoff-levels-to-rule-out-pulmonary-embolism-in-patients-hospitalized-for-copd-exacerbation-results-from-the-slice-trial/. Accessed October 1, 2023.
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