Richardson Jordan S, Clark Carol L, Bastani Aveh, Shams Ali H, Fermann Gregory J, Hiestand Brian C, Kea Bory, Mace Sharon E, Peacock W Frank, Yang Alex, Welker James A
Department of Emergency Medicine, Corewell Health William Beaumont University Hospital, Royal Oak, MI, USA.
Department of Emergency Medicine, Corewell Health Beaumont Hospital-Troy, Troy, MI, USA.
Clin Appl Thromb Hemost. 2025 Jan-Dec;31:10760296251320406. doi: 10.1177/10760296251320406.
The study's main aim was to determine the prevalence of elevated D-dimer levels in adult patients hospitalized for acute medical illnesses not suspected to have venous thromboembolism (VTE). The secondary aims were to determine VTE prophylaxis rates and VTE events.
This multicenter, prospective, observational study included patients who were admitted across nine US hospitals. Patients who were ≥60 years of age, admitted for an acute medical illness (nonsurgical/nontraumatic), and not suspected to have VTE (deep vein thrombosis [DVT]/pulmonary embolism [PE]) were enrolled. Current use of anticoagulation and recent major surgery were exclusion criteria. D-dimers were measured at hospital admission, and the analysis was performed at a central laboratory using the STA-Liatest D-Di test kit (Diagnostica Stago, Asnières sur Seine, France). The upper limit of normal (ULN) for D-dimer was defined as ≥500 ng/mL. Age-adjusted thresholds were calculated as age × 10 ng/mL. VTE events included symptomatic DVT (distal or proximal) or PE occurring during admission.
Among 995 patients (50.7% female; mean age, 70 ± 8 years), 74.4% (n = 740) had a D-dimer ≥ ULN, 62.2% (n = 619) had elevated age-adjusted levels, and 48.8% (n = 486) had D-dimers at least two times the ULN. The rate of VTE prophylaxis was 66.5% (n = 662); in this cohort, 1.8% (n = 18) developed a VTE.
Most hospitalized acute medically ill patients ≥60 years of age had elevated D-dimer levels on admission. Although an elevated D-dimer may be associated with VTE risk, its poor specificity indicates that it should not guide prophylaxis management without a multifactor risk assessment.
本研究的主要目的是确定因急性内科疾病住院且未怀疑有静脉血栓栓塞症（VTE）的成年患者中D-二聚体水平升高的患病率。次要目的是确定VTE预防率和VTE事件。
这项多中心、前瞻性、观察性研究纳入了美国9家医院收治的患者。纳入年龄≥60岁、因急性内科疾病（非手术/非创伤性）入院且未怀疑有VTE（深静脉血栓形成[DVT]/肺栓塞[PE]）的患者。目前使用抗凝剂和近期进行大手术为排除标准。在入院时检测D-二聚体，并在中央实验室使用STA-Liatest D-Di检测试剂盒（Diagnostica Stago，法国塞纳河畔阿涅尔）进行分析。D-二聚体的正常上限（ULN）定义为≥500 ng/mL。年龄校正阈值计算为年龄×10 ng/mL。VTE事件包括入院期间发生的有症状DVT（远端或近端）或PE。
在995例患者中（50.7%为女性；平均年龄70±8岁），74.4%（n = 740）的D-二聚体≥ULN，62.2%（n = 619）的年龄校正水平升高，48.8%（n = 486）的D-二聚体至少为ULN的两倍。VTE预防率为66.5%（n = 662）；在该队列中，1.8%（n = 18）发生了VTE。
大多数≥60岁因急性内科疾病住院的患者入院时D-二聚体水平升高。尽管D-二聚体升高可能与VTE风险相关，但其特异性较差表明，在没有多因素风险评估的情况下，它不应指导预防管理。
