Value of Red Blood Cell Distribution Width on Emergency

Department Admission in Patients With Venous

Thrombosis
Giuseppe Lippi, MDa,*, Ruggero Buonocore, PhDa, and Gianfranco Cervellin, MDb

Red blood cell distribution width (RDW) was found to be a useful parameter in a variety of
cardiovascular and thrombotic disorders. Therefore, we conducted a retrospective case
econtrol study to establish whether an association exists between RDW and venous
thrombosis. The study population consisted of 431 consecutive patients who received a
diagnosis of venous thrombosis in the emergency department (ED), thus including cases of
superficial venous thrombosis, deep vein thrombosis (DVT), and/or pulmonary embolism
(PE). The control population consisted of 967 matched outpatients who underwent routine
laboratory testing. The RDW values were found to be significantly increased in patients
with venous thrombosis compared to controls, with an incremental trend of values from
patients with superficial thrombosis, isolate DVT, to PE. Increased RDW values were an
independent risk factor for isolate DVT and PE, displaying a relative risk that was greater
in patients with provoked DVT and PE that in those with unprovoked thrombosis after
multiple adjustment for age, gender, hemoglobin, and mean corpuscular volume. Inter-
estingly, RDW also exhibited a significant diagnostic performance at ED admission, dis-
playing an area under the curve of 0.65 (95% confidence interval [CI] 0.62 to 0.68; p <0.001)
for all cases of venous thrombosis, 0.63 (95% CI 0.59 to 0.68; p <0.001) for isolate DVT, and
0.70 (95% CI 0.65 to 0.75; p <0.001) for PE. The results of this study suggest that increased
RDW not only is associated with venous thrombosis but may also increase the efficiency of
baseline risk assessment of patients with suspected venous thrombosis on ED
admission. Ó 2016 Elsevier Inc. All rights reserved. (Am J Cardiol 2016;117:670e675)

It is now well established that the identification of clinical
and biological correlates of venous thrombosis represents a
cornerstone for preventing both venous thromboembolism
(VTE) and superficial venous thrombosis.1 Recent evidence
attests that the red blood cell distribution width (RDW), a
conventional measure of anisocytosis, might be a useful
parameter for gathering meaningful clinical information, either
diagnostic or prognostic, on a variety of cardiovascular and
thrombotic disorders.2,3 In particular, although a convincing
association has been demonstrated between RDW values and
all-cause, noncardiac, and cardiac mortality in patients with
coronary heart disease,4 scarce and even contradictory infor-
mation is available on the relation between anisocytosis and
venous thrombosis.5e11 Therefore, we conducted a retrospec-
tive caseecontrol study to establish whether an association
may exist between anisocytosis and venous thrombosis.
Methods
The study population consisted of all consecutive patients
who received a diagnosis of venous thrombosis (i.e.,
a
Section of Clinical Biochemistry, Department of Neurological,
Biomedical and Movement Sciences, University of Verona, Verona, Italy
and bEmergency Department, Academic Hospital of Parma, Parma, Italy.
Manuscript received September 13, 2015; revised manuscript received and
accepted November 18, 2015.
See page 674 for disclosure information.
*Corresponding author: Tel: (þ39) 0458124308; fax: (þ39)
0458122970.
E-mail address: giuseppe.lippi@univr.it; ulippi@tin.it (G. Lippi).
superficial venous thrombosis, deep vein thrombosis [DVT],
and/or pulmonary embolism [PE]) at the emergency depart-
ment (ED) of the University Hospital of Parma (Italy) during
the entire year of 2014. The facility is a 1,250-bed teaching
general hospital, serving a population of approximately
435,000 inhabitants. The diagnoses of venous thrombosis,
which were always made in the local facility in accord with the
guidelines of the American College of Chest Physicians,12
were systematically extracted from local hospital records
according to specific International Classification of Diseases,
Ninth Revision, codes and related diagnostic terms. Unpro-
voked thrombosis was defined according to conventional
criteria,13 as having none of the following risk factors: preg-
nancy, cancer in the past 5 years, recent (i.e., in the past
3 months) surgery, trauma, hospitalization, immobilization,
or long-haul flight (>4 hours). The data were then reviewed
by 2 expert physicians for deleting wrong or dubious records.
The controls consisted in a matched population of outpatients
from the same geographical area, who underwent routine
laboratory testing for health check-up during the entire year of
2014. Subjects with a previous diagnosis of venous throm-
bosis (n ¼ 17) as reported in the medical prescription (the
inclusion of the diagnosis in the medical prescription is
mandatory in Italy) were excluded. Notably, only venous
thrombosis diagnosed in the local ED has been included, thus
excluding all episodes diagnosed during hospital staying. The
complete blood cell count, thus including the assessment of
hemoglobin, mean corpuscular volume (MCV), and RDW,
was performed in blood samples (13  75, 2.0-ml plastic
whole blood tube containing spray-coated K2EDTA; Becton

0002-9149/15/$ - see front matter Ó 2016 Elsevier Inc. All rights reserved. www.ajconline.org
http://dx.doi.org/10.1016/j.amjcard.2015.11.024
 Miscellaneous/RDW and Venous Thrombosis 671

Table 1
Demographic and hematological data (median and interquartile range) in unselected control outpatients, and patients with venous thromboembolism (VTE)
Variable Controls All cases p* Superficial p* DVT p* PE and p*
thrombosis DVT þ PE

n¼967 n¼431 - n¼58 - n¼213 - n¼160 -

Age (years) 72 (59-82) 75 (60-84) 0.265 67 (52-77) <0.001 74 (57-83) 0.309 78 (69-86) <0.001
Women 567/967 (59%) 268/431 (62%) 0.117 39/58 (67%) 0.124 127/213 (60%) 0.425 102/160 (64%) 0.129
Unprovoked thrombosis - 282/431 (65%) - 44/58 (76%) - 149/213 (70%) - 88/160 (55%) -
Hemoglobin (g/L) 136 (128-147) 137 (124-148) 0.103 138 (127-148) 0.380 137 (125-144) 0.057 139 (123-148) 0.290
MCV (fL) 90.0 (86.9-92.8) 89.9 (86.4-93.7) 0.401 89.1 (83.6-92.6) 0.001 89.7 (86.7-93.6) 0.411 91.0 (86.8-94.1) 0.172
RDW (%)
Values 13.6 (13.1-14.3) 14.2 (13.5-15.2) <0.001 13.9 (13.2-14.5) 0.001 14.1 (13.4-15.2) <0.001 14.5 (13.6-15.6) <0.001
RDW >14.5% 201/967 (21%) 179/431 (42%) <0.001 16/58 (28%) 0.143 81/213 (38%) <0.001 82/160 (51%) <0.001

DVT ¼ deep vein thrombosis; MCV ¼ mean corpuscular volume; PE ¼ pulmonary embolism; RDW ¼ red blood cell distribution width.
* Compared to controls.

Figure 1. Values of RDW (median and interquartile range) in a control population of unselected outpatients and in patients with different forms of venous
thrombosis.

Dickinson Italia S.p.A., Milan, Italy) collected from cases at
ED admission and from outpatients during the health check-
up, respectively. All measurements were concluded within
2 hours from blood drawing, using an identical hematologic
analyzer (Sysmex XE-2100; Sysmex Co., Kobe, Japan). The
quality and comparability of results was guaranteed by
routine performance of internal quality controls and partici-
pation to an external quality assessment scheme.
Results were finally shown as median and interquartile
range or percentage. The significance of difference was
analyzed with ManneWhitney test (for continuous variables)
and Pearson chi-square test (for categorical values). A
multivariate analysis was also used to identify potential as-
sociations with venous thrombosis. Diagnostic significance
was estimated by receiver operating characteristics curve.
The crude and multivariate adjusted relative risk with
95% confidence interval (CI) was finally estimated. The an-
alyses including RDW values were based on dichotomous
exposures, using the instrument-specific cut-off value of
14.6%.14 Statistical analysis was performed using Analyse-it
(Analyse-it Software Ltd, Leeds, UK) and MedCalc Version
12.3.0 (MedCalc Software, Mariakerke, Belgium). This
retrospective study was performed in accordance with the
Declaration of Helsinki, under the terms of relevant local
legislation, and was cleared by the institutional review board.
Results
A total number of 431 patients received a final diagnosis
of venous thrombosis throughout the study period after
excluding inappropriate or dubious records. For statistical
analysis, patients with a diagnosis of isolate PE (n ¼ 117)
and those with both DVT and PE (n ¼ 43) were grouped in
the same class (i.e., PE). Overall, 149 patients were diag-
nosed with provoked thrombosis (55 with primary diagnosis
of cancer, 16 with recent trauma, 14 with infections, 10 with
672 The American Journal of Cardiology (www.ajconline.org)

Table 2
Values of RDW (median and interquartile range) in unselected control outpatients and in patients with unprovoked and provoked venous thromboembolism
(VTE)
Unprovoked Controls All cases p* Superficial p* DVT p* PE and p*
thrombosis DVT þ PE

n¼967 n¼282 - n¼44 - n¼149 - n¼88 -

Age (years) 72 (59-82) 76 (60-85) 0.126 64 (50-76) <0.001 76 (61-84) 0.251 80 (69-87) <0.001
Women 567/967 (59%) 183 (65%) 0.035 30/44 (68%) 0.135 90/149 (60%) 0.375 63/88 (72%) 0.012
RDW
Values (%) 13.6 (13.1-14.3) 14.1 (13.4-14.9) <0.001 13.9 (13.3-14.5) 0.001 14.0 (13.3-14.7) <0.001 14.3 (13.4-15.2) <0.001
RDW >14.5% 201/967 (21%) 101/282 (36%) <0.001 13/44 (30%) 0.115 46/149 (31%) 0.004 41/88 (47%) <0.001

Provoked n¼967 n¼149 - n¼14 - n¼64 - n¼72 -

Age (years) 72 (59-82) 74 (59-82) 0.326 71 (59-77) 0.179 71 (56-80) 0.018 76 (68-85) 0.043
Women 567/967 (59%) 85 (57%) 0.391 9/14 (64%) 0.439 37/64 (58%) 0.449 39/72 (54%) 0.268
RDW
Values (%) 13.6 (13.1-14.3) 14.6 (13.7-15.7) <0.001 14.0 (13.1-14.3) 0.232 14.6 (13.8-15.8) <0.001 14.8 (13.9-15.8) <0.001
RDW >14.5% 201/967 (21%) 78/149 (52%) <0.001 3/14 (21%) 0.476 35/64 (55%) <0.001 41/72 (57%) <0.001

DVT ¼ deep vein thrombosis; PE ¼ pulmonary embolism; RDW ¼ red blood cell distribution width.
* Compared to controls.

Table 3
Relative risk (and 95% confidence interval) of venous thrombosis for values of red blood cell distributions width (RDW) >14.6%
All cases of venous thrombosis Superficial DVT PE and
thrombosis DVT þ PE

Unadjusted
Unprovoked and provoked 2.00 (95% CI, 1.69-2.36; p <0.001) 1.33 (95% CI, 0.86-2.05; 1.83 (95% CI, 1.48-2.26; 2.46 (95% CI, 2.03-3.00;
p¼0.202) p<0.001) p<0.001)
Unprovoked 1.72 (95% CI, 1.41-2.10; p<0.001) 1.42 (95% CI, 0.89-2.28; 1.49 (95% CI, 1.13-1.95; 2.24 (95% CI, 1.74-2.89;
p¼0.145) p¼0.004) p<0.001)
Provoked 2.52 (95% CI, 2.07-3.07; p<0.001) 1.03 (95% CI, 0.38-2.83; 2.63 (95% CI, 2.04-3.39; 2.74 (95% CI, 2.16-3.47;
p¼0.953) p<0.001) p<0.001)
Adjusted*
Unprovoked and provoked 1.38 (95% CI, 1.19-1.59; p<0.001) 1.26 (95% CI, 0.90-1.75; 1.31 (95% CI, 1.09-1.58; 1.39 (95% CI, 1.14-1.69;
p¼0.175) p¼0.004) p¼0.001)
Unprovoked 1.36 (95% CI, 1.16-1.60; p<0.001) 1.37 (95% CI, 0.96-1.95; 1.28 (95% CI, 1.03-1.59; 1.37 (95% CI, 1.06-1.77;
p¼0.080) p¼0.027) p¼0.017)
Provoked 1.43 (95% CI, 1.17-1.74; p<0.001) 1.13 (95% CI, 0.56-2.30; 1.54 (95% CI, 1.17-2.01; 1.41 (95% CI, 1.07-1.85;
p¼0.731) p¼0.002) p¼0.014)

DVT ¼ deep vein thrombosis; PE ¼ pulmonary embolism.

* Adjusted for age, sex, hemoglobin and mean corpuscular volume.

recent surgery, 2 in the postpartum period, and the
remaining 55 with other causes).
The main characteristics of the entire study population are
provided in Table 1. No significant differences were observed
for age, gender, hemoglobin, and MCV when the control
population was compared to patients with venous thrombosis,
except for the older age of patients with PE and the younger
age of those with superficial venous thrombosis. The RDW
values were significantly increased in all the different pop-
ulations of patients with venous thrombosis, exhibiting an
incremental trend from patients with superficial thrombosis to
those with isolate DVT and those with isolate PE or DVT
plus PE (Figure 1). Interestingly, the RDW values were also
greater in patients with isolate PE or DVT plus PE compared
to those with superficial thrombosis or isolate DVT, whereas
no difference was found between patients with superficial
thrombosis or isolate DVT (Figure 1). The frequency of
patients with RDW values >14.6% was similar between
controls and patients with superficial venous thrombosis,
whereas it was nearly double in both the populations of pa-
tients with all types of venous thrombosis and isolate DVT
and was even greater in patients with isolate PE or DVT plus
PE. A similar trend was observed when patients were strati-
fied according to unprovoked or provoked thrombosis
(Table 2). In multivariate analysis, in which the diagnosis of
venous thrombosis was entered as dependent variable
whereas age, gender, hemoglobin, MCV and RDW were
entered as independent variables, a diagnosis of all types of
venous thrombosis was found to be significantly associated
with gender (b coefficient 0.06; p ¼ 0.020), age (b
coefficient 0.01, p ¼ 0.024), and RDW (b coefficient 0.11;
p <0.001); superficial venous thrombosis was found to be
significantly associated with gender (b coefficient 0.033;
p ¼ 0.046), age (b coefficient 0.02; p <0.001), and RDW
 Miscellaneous/RDW and Venous Thrombosis
Figure 2. Receiver operating characteristics curve of RDW for diagnosing
all cases of venous thrombosis, DVT, and isolate PE or DVT and PE.
(b coefficient 0.029; p <0.001); isolate DVT was found to be
significantly associated with age (b coefficient 0.02; p ¼
0.007) and RDW (b coefficient 0.08; p <0.001), whereas PE
673
was found to be significantly associated with gender (b
coefficient 0.05; p ¼ 0.025) and RDW (b coefficient 0.09;
p <0.001). Accordingly, increased RDW values were found
to be a significant risk factor for isolate DVT and PE,
exhibiting a relative risk that was greater in patients with
provoked DVT and PE that in those with unprovoked
thrombosis both in unadjusted analysis and after multiple
adjustment for age, gender, hemoglobin, and MCV (Table 3).
Interestingly, RDW exhibited a significant diagnostic per-
formance at ED admission, with an area under the curve
(AUC) of 0.65 (95% CI 0.62 to 0.68; p <0.001) for all cases
of venous thrombosis, 0.63 (95% CI 0.59 to 0.68; p <0.001)
for isolate DVT, and 0.70 (95% CI 0.65 to 0.75; p <0.001)
for PE, respectively (Figure 2). The conventional cut-off
value of 14.6% was characterized by 0.75 negative predic-
tive value (NPV) and 0.48 positive predictive value (PPV) for
all cases of venous thrombosis, 0.85 NPV and 0.30 PPV for
DVT, and 0.91 NPV and 0.30 PPV for PE, respectively.
Unlike VTE, the diagnostic value of RDW was found to be
poor for superficial venous thrombosis (AUC 0.57; 95% CI
0.49 to 0.65; p ¼ 0.051).
Discussion
Several lines of evidence now attest that an intriguing
relation does exist between anisocytosis and ischemic heart
disease. More specifically, increased RDW values were
found to be significant predictors of both the onset and
adverse outcomes in patients with myocardial infarction.2,3
However, more controversial data have been published
about the relation between anisocytosis and venous
thrombosis.
Zorlu et al5 prospectively followed 136 patients with
confirmed acute PE for 11  7 days and reported that
increased RDW >14.6% on admission (hazard ratio [HR]
15.5; 95% CI 1.8 to 132.1; p ¼ 0.012) was independently
associated with increased risk for acute PE-related early
mortality in multivariate analysis. In an ensuing retrospec-
tive cohort study, Abul et al6 enrolled 203 consecutive pa-
tients with acute PE, who were then followed for a median
period of 27 months for the development of chronic
thromboembolic pulmonary hypertension. In multivariate
regression analysis, patients with an increased RDW value
(i.e., >14.6%) had a 58% greater risk of developing chronic
thromboembolic pulmonary hypertension on follow-up (HR
1.58; 95% CI 1.09 to 2.30; p ¼ 0.016). Zöller et al7 per-
formed a population-based cohort study including 27,042
subjects without previous history of VTE or cancer, who
were followed up for a mean period of 13.8 years. In Cox
proportional hazards regression, patients in the highest
quartile of RDW were found to have a 74% greater risk of
developing VTE on follow-up (HR 1.74; 95% CI 1.38 to
2.21; p <0.001). More recently, Bucciarelli et al8 carried out
a caseecontrol study including 730 patients with a first
objectively confirmed episode of VTE (300 unprovoked and
430 provoked) and 352 healthy controls. Patients with an
increased RDW value (i.e., >14.6%) were found to have a
remarkably greater risk of VTE (odds ratio [OR] 2.52; 95%
CI 1.42 to 4.47). Interestingly, the risk was found to be
similar in patients with unprovoked (OR 2.88; 95% CI 1.56
to 5.33) or provoked (OR 2.80; 95% CI 1.35 to 5.79)
674 The American Journal of Cardiology (www.ajconline.org)
thrombosis but was found to be higher in patients with PE
(OR 3.19; 95% CI 1.68 to 6.09) than in those with isolated
DVT (OR 2.29; 95% CI 1.22 to 4.30). At variance with
these findings, Riedl et al9 performed a prospective obser-
vational cohort study in which RDW was measured in 1,840
patients with various forms of newly diagnosed or pro-
gressive cancer after remission. Although a high RDW
value (i.e., >16.0%) was found to be a significant predictor
of mortality, no association was found with the risk of VTE
in the total study cohort (HR 1.12; 95% CI 0.67 to 1.87; p ¼
0.678). Ellingsen et al10 also measured RDW at baseline in
26,223 participants in the Tromsø Study, who were fol-
lowed for the development of VTE for a median period of
16.8 years. In multiadjusted analysis, patients with RDW
values above the ninety-fifth percentile had a significantly
increased risk of VTE (HR 1.8; 95% CI 1.2 to 2.7). The risk
of VTE was found to be similar for patients with provoked
(HR 1.4; 95% CI 1.0 to 1.9) and unprovoked (HR 1.6; 95%
CI 1.1 to 2.4) VTE and in those with provoked (HR 1.6;
95% CI 0.9 to 3.0) and unprovoked (HR 1.5; 95% CI 0.8 to
2.6) PE, although the risk estimates for PE did not reach
statistical significance. Xu et al11 carried out a retrospective
cross-sectional study including 55 patients with DVT and 55
control subjects who underwent total joint arthroplasty and
failed to find a significant difference of RDW values be-
tween the DVT and the control groups (13.1  0.1 vs 13.1
 0.1; p ¼ 0.84).
Taken together, the results of our retrospective case-
econtrol study confirm that a graded and independent asso-
ciation between RDW and risk of venous thrombosis does
exist in patients diagnosed with VTE in the ED (Table 3).
Interestingly, a greater degree of anisocytosis mirrors the
presence of multiple metabolic imbalances (especially
ongoing inflammation),15 which are ultimately associated
with an increased risk of morbidity and mortality in the gen-
eral population.16 It is hence not surprising that the risk of
VTE was found to be greater in patients with provoked
thrombosis than in those with spontaneous VTE because this
would probably reflect the presence of concomitant pro-
thrombotic conditions. It is also noteworthy that the RDW
value at ED admission was found to provide valuable diag-
nostic information. An NPV of 0.85 and 0.91 for diagnosing
isolate DVT and PE, respectively, would hence allow a pre-
liminary classification of patients with suspected VTE and
displaying an RDW value 14.6% in a class of probable low-
risk probability, thus paving the way to further studies aimed
to establish whether the integration of RDW within classic
scoring systems (e.g., the Wells Score or the Revised Geneva
Score)17 may increase the efficiency of baseline risk assess-
ment. Although D-dimer has represented the biochemical gold
standard for diagnosing venous thrombosis for decades,18
RDW can be systematically calculated by virtually all he-
mocytometers and automatically reported. Therefore, at
variance with D -dimer and other biomarkers,19 its assessment
and inclusion within diagnostic algorithms would be
completely inexpensive for health care systems, especially
those increasingly plagued by shortage of economical and
human resources.20
At variance with previous studies,5e11 we have also
investigated for the first time the potential association be-
tween anisocytosis and superficial venous thrombosis.
Despite RDW values were found to be marginally but
significantly greater in patients diagnosed with this condi-
tion (Figure 1), the risk estimates did not reach statistical
significance, nor RDW assessment at ED admission was
found to be ultimately useful for identifying patients with
superficial venous thrombosis (AUC 0.57; p ¼ 0.051).
Although the pathogenesis of venous thrombosis partially
overlaps with that of VTE, the presence of localized
inflammation and anatomic abnormalities, namely varicose
veins, are regarded as important contributing factors,21 but
neither of these conditions may significantly interplay with
anisocytosis.
Disclosures
The authors have no conflicts of interest to disclose.
1. Lefebvre P, Laliberté F, Nutescu EA, Duh MS, LaMori J, Bookhart
BK, Olson WH, Dea K, Hossou Y, Schein J, Kaatz S. All-cause and
disease-related health care costs associated with recurrent venous
thromboembolism. Thromb Haemost 2013;110:1288e1297.
2. Zalawadiya SK, Veeranna V, Niraj A, Pradhan J, Afonso L. Red cell
distribution width and risk of coronary heart disease events. Am J
Cardiol 2010;106:988e993.
3. Montagnana M, Cervellin G, Meschi T, Lippi G. The role of red blood
cell distribution width in cardiovascular and thrombotic disorders. Clin
Chem Lab Med 2011;50:635e641.
4. Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell
distribution width: a simple parameter with multiple clinical applica-
tions. Crit Rev Clin Lab Sci 2015;52:86e105.
5. Zorlu A, Bektasoglu G, Guven FM, Dogan OT, Gucuk E, Ege MR,
Altay H, Cinar Z, Tandogan I, Yilmaz MB. Usefulness of admission
red cell distribution width as a predictor of early mortality in patients
with acute pulmonary embolism. Am J Cardiol 2012;109:128e134.
6. Abul Y, Ozsu S, Korkmaz A, Bulbul Y, Orem A, Ozlu T. Red cell
distribution width: a new predictor for chronic thromboembolic pul-
monary hypertension after pulmonary embolism. Chron Respir Dis
2014;11:73e81.
7. Zöller B, Melander O, Svensson P, Engström G. Red cell distribution
width and risk for venous thromboembolism: a population-based cohort
study. Thromb Res 2014;133:334e339.
8. Bucciarelli P, Maino A, Felicetta I, Abbattista M, Passamonti SM,
Artoni A, Martinelli I. Association between red cell distribution width
and risk of venous thromboembolism. Thromb Res 2015;136:
590e594.
9. Riedl J, Posch F, Königsbrügge O, Lötsch F, Reitter EM, Eigenbauer E,
Marosi C, Schwarzinger I, Zielinski C, Pabinger I, Ay C. Red cell
distribution width and other red blood cell parameters in patients with
cancer: association with risk of venous thromboembolism and mortal-
ity. PLoS One 2014;9:e111440.
10. Ellingsen TS, Lappegård J, Skjelbakken T, Brækkan SK, Hansen JB.
Red cell distribution width is associated with incident venous throm-
boembolism (VTE) and case-fatality after VTE in a general population.
Thromb Haemost 2015;113:193e200.
11. Xu Z, Li L, Shi D, Chen D, Dai J, Yao Y, Teng H, Jiang Q. The level
of red cell distribution width cannot identify deep vein thrombosis in
patients undergoing total joint arthroplasty. Blood Coagul Fibrinolysis
2015;26:298e301.
12. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuünemann HJ;
American College of Chest Physicians Antithrombotic Therapy and
Prevention of Thrombosis Panel. Executive summary: Antithrombotic
Therapy and Prevention of Thrombosis, 9th ed: American College of
Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest
2012;141(2 Suppl):7Se47S.
13. van Hylckama Vlieg A, Flinterman LE, Bare LA, Cannegieter SC,
Reitsma PH, Arellano AR, Tong CH, Devlin JJ, Rosendaal FR. Genetic
variations associated with recurrent venous thrombosis. Circ Car-
diovasc Genet 2014;7:806e813.
14. Lippi G, Pavesi F, Bardi M, Pipitone S. Lack of harmonization of red
blood cell distribution width (RDW). Evaluation of four hematological
analyzers. Clin Biochem 2014;47:1100e1103.
 Miscellaneous/RDW and Venous Thrombosis
15. Lippi G, Targher G, Montagnana M, Salvagno GL, Zoppini G, Guidi
GC. Relation between red blood cell distribution width and inflam-
matory biomarkers in a large cohort of unselected outpatients. Arch
Pathol Lab Med 2009;133:628e632.
16. Lippi G, Plebani M. Red blood cell distribution width (RDW) and
human pathology. One size fits all. Clin Chem Lab Med 2014;52:
1247e1249.
17. Lippi G, Danese E, Favaloro EJ, Montagnana M, Franchini M. Di-
agnostics in venous thromboembolism: from origin to future prospects.
Semin Thromb Hemost 2015;41:374e381.
18. Lippi G, Mattiuzzi C. The biomarker paradigm: between diagnostic ef-
ficiency and clinical efficacy. Pol Arch Med Wewn 2015;125:282e288.
675
19. Lippi G, Franchini M, Targher G, Favaloro EJ. Help me, Doctor! My
D-dimer is raised. Ann Med 2008;40:594e605.
20. Agarwal S, Clark D 3rd, Sud K, Jaber WA, Cho L, Menon V. Gender
disparities in outcomes and resource utilization for acute pulmonary
embolism hospitalizations in the United States. Am J Cardiol
2015;116:1270e1276.
21. Decousus H, Quéré I, Presles E, Becker F, Barrellier MT, Chanut M,
Gillet JL, Guenneguez H, Leandri C, Mismetti P, Pichot O, Leizorovicz
A; POST (Prospective Observational Superficial Thrombophlebitis)
Study Group. Superficial venous thrombosis and venous thromboem-
bolism. A large, prospective epidemiologic study. Ann Intern Med
2010;152:218e224.