Presenter(s) and Chair: Dr. Wahaballah Abdullah and Prof. Rob Galloway / Codes: SLO1, SLO10, VC3 / Published: 17/03/2026
Summary
Dr Wahaballah Abdullah and Prof. Rob Galloway presented an overview of the ADJUST-DVT study; a multicentre prospective cohort study that compared a strategy of using age adjusted D-dimer versus standard cutoff level to rule out DVT in low-risk patients. The discussion explored the handling of protocol breaches in the analysis, the differences between the intention-to-diagnose versus the per protocol analyses and the clinical implications of this trial.
Key Learning Points
- How protocol breaches are handled in the analyses can have a huge impact on the internal validity of the results.
- Loss to follow-up is a key weakness that affects most prospective cohort studies.
- Clinical gestalt is key despite negative D-dimers and low risk stratification on the Wells score some patients still underwent compression ultrasonography because of clinical suspicion.
- Convenience sampling can result in selection bias as patients recruited out-of-hours are less likely to be included.
Original Journal Article Title: Age-Adjusted D-dimer Cutoff Levels to Rule Out Deep Vein Thrombosis
Original Journal Article Reference: https://jamanetwork.com/journals/jama/article-abstract/2843503
