Raising the D-dimer bar - a narrative review of the age-adjusted D-dimer threshold

Sep 30, 2026

D-dimers are central to diagnosing venous thromboembolism (VTE) because negative results carry high predictive value for excluding VTE in patients with non-high clinical probability. Yet D-dimer concentrations rise naturally with age, complicating interpretation in older adults. This narrative review evaluates the age-adjusted D-dimer threshold, using age × 10 (µg/L) from age 50, focusing on HemosIL assays. The approach improves specificity without sacrificing sensitivity for suspected pulmonary embolism in emergency settings, potentially reducing imaging use and costs. Real-world studies, especially for deep vein thrombosis, remain limited and assay-specific validation is required.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages19

Reading Time48 min

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Introduction

The age-adjusted D-dimer threshold

[https://doi.org/10.1016/j.rpth.2025.103255](https://doi.org/10.1016/j.rpth.2025.103255) R EV I EW A RT IC L E Raising the D-dimer bar: a narrative review of the age-adjusted D-dimer threshold Tayssir Fatah1 | Judith Catella2,3 | Christophe Nougier1,4 | Hamdi Rezigue1,4 1Service d’H´ematologie Biologique etd’H´emostase clinique, Hospices Civils de Lyon, Bron, France 2Service de M´edecine Interne et Vasculaire, Hˆopital Edouard Herriot, Hospices Civils de Lyon, Lyon, France 3Laboratoire Interuniversitaire de Biologie de la Motricit´e (LIBM) EA7424, Équipe“Biologie Vasculaire et du Globule Rouge,”Universit´e Claude Bernard Lyon 1 Universit´e de Lyon, Lyon, France 4UR4609-H´emostase et Thrombose, UFRLaennec, Universit´e Claude Bernard, Lyon, France Correspondence Hamdi Rezigue, Hospices Civils de Lyon, Groupement Hospitalier Est, Serviced’h´ematologie biologique et d’h´emostaseclinique, 59 Boulevard Pinel, 69677 Bron Cedex, France. Email: [hamdi.rezigue@chu-lyon.fr](hamdi.rezigue@chu-lyon.fr) Handling Editor: Dr Alberto Tossetto Abstract D-dimers play a key role in diagnosing venous thromboembolism (VTE) due to high negative predictive value in excluding VTE in patients with a nonhigh clinical probability. However, D-dimer levels naturally increase with age, complicating their interpretation in elderly patients. To address this, an age-adjusted threshold multiplying the patient’sage by 10 (μg/L), starting from age 50 years, has been proposed in several studies, to exclude the diagnosis of VTE in patients over 50 years with a nonhigh clinical probability. This narrative review discusses the establishment as well as the efficiency and safety of the age-adjusted threshold multiplying the patient’s age by 10 (μg/L), with a focus on the HemosIL D-dimer assays. Overall, the age-adjusted D-dimer threshold has demonstrated enhanced specificity without compromising sensitivity in excluding VTEin patients with suspected pulmonary embolism and nonhigh clinical probability in emergency department settings. By improving specificity, reducing imaging reliance, and lowering costs, the age-adjusted threshold offers a cost-effective and efficient strategy for optimizing VTE management. However, real-world diagnostic strategy studies remain limited, particularly for deep vein thrombosis. Retrospective studies dominate this area, and the cautious stance of scientific societies reflects the absence of largescale, prospective trials. Emerging evidence suggests the age-adjusted threshold maybe as safe and efficient as the conventional approach for deep vein thrombosis exclusion. More than 30 commercial assays are available for D-dimer testing, and the age-adjusted threshold is not validated with all commercially available D-dimer techniques. This underscores the critical need for assay-specific validation before ageadjusted thresholds can be reliably integrated into routine clinical practice. K EYW O R DS D-dimer, deep vein thrombosis, fibrin, pulmonary embolism, venous thromboembolism Essentials • D-dimer levels naturally increase with age. • D-dimers exclude venous thromboembolism with a high negative predictive value. • An age-adjusted threshold (age × 10 μg/L) has been proposed for patients over 50 years old. • This threshold is not validated across all commercially available D-dimer assay. © 2025 The Author(s). Published by Elsevier Inc. on behalf of International Society on Thrombosis and Haemostasis. This is an open access article under the CC BY license ([http://creativecommons.org/licenses/by/4.0/](http://creativecommons.org/licenses/by/4.0/)). Res Pract Thromb Haemost. 2026;10:e103255 [www.rpthjournal.org](www.rpthjournal.org- 1 of)[-](www.rpthjournal.org- 1 of)[ 1 of](www.rpthjournal.org- 1 of) 19 [https://doi.org/10.1016/j.rpth.2025.103255](https://doi.org/10.1016/j.rpth.2025.103255) 2 of 19 ■ FATAH ET AL. 1 | INTRODUCTION Diagnostic of venous thromboembolism (VTE), encompassing de

FAQs

Why are D-dimer tests important in venous thromboembolism (VTE) diagnosis?

D-dimers support VTE diagnosis because a negative result—when clinical probability is non-high—provides a high negative predictive value for excluding VTE. This applies to both deep vein thrombosis and pulmonary embolism.

How does the age-adjusted D-dimer threshold work?

It uses a threshold calculated as the patient’s age multiplied by 10 (µg/L), starting from age 50. The goal is to exclude VTE more appropriately in older patients with non-high clinical probability.

What are the main limitations of using age-adjusted thresholds?

Evidence is limited in real-world diagnostic strategy studies, especially for deep vein thrombosis, and retrospective studies dominate. In addition, the age-adjusted threshold is not validated across all commercially available D-dimer assay techniques, requiring assay-specific validation.

Sep 30, 2026

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