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December 24/31, 2003

Identifying Patients at Risk of Recurrent Venous Thromboembolism—Reply

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2003;290(24):3192. doi:10.1001/jama.290.24.3192-a

To the Editor: Dr Eichinger and colleagues1 found that D-dimer levels measured after a single occurrence of idiopathic venous thromboembolism (VTE) were related to future risk of recurrent VTE. Their D-dimer cutoff levels (250 ng/mL, 500 ng/mL, and 750 mg/mL), however, are assay-specific. In ruling out VTE, for example, optimal threshold values for some enzyme-linked immunoassays (ELISAs) are as low as 40 ng/mL but may be more than 500 ng/mL for others.2 Similarly, different quantitative non-ELISAs may require different cutoff values in the exclusion of VTE.3,4 The threshold used by Eichinger et al to define those patients at low risk for recurrence (ie, <250 mg/mL) is half the value used to exclude VTE (<500 ng/mL) with that particular assay (Asserachrom D-dimer, Boehringer Mannheim, Mannheim, Germany).5

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