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We read with great interest the Article by Renato D Lopes and colleagues1 showing that, among patients hospitalised with COVID-19 and elevated D-dimer concentration, in-hospital therapeutic anticoagulation with rivaroxaban or enoxaparin followed by rivaroxaban to day 30 did not improve clinical outcomes but increased bleeding compared with prophylactic anticoagulation. However, in their analysis, the authors do not appear to have adequately considered the potential influence of the D-dimer concentration calculated with an age-adjusted cutoff.2 According to current international guidelines,3, 4 an age-adjusted D-dimer test threshold must be considered for people older than 50 years, as in the case of this study, in which the mean age was 56·6 years (SD 14·3). Furthermore, considering that risk of mortality and severe forms of COVID-19 pneumonia increase with ageing,5 it seems reasonable to prefer the adoption of an age-adjusted cutoff in this patient group. Therefore, the results of this large, multicentre, randomised trial should be interpreted cautiously for patients with COVID-19. © 2021 Silvio Avila/Getty Images2021