Performance of the age-adjusted cut-off for D-dimer in patients with cancer and suspected pulmonary embolism. Issue 152 (April 2017)

• Record Type: Journal Article
• Authors: Wilts, I.T.; Le Gal, G.; Den Exter, P.L.; Van Es, J.; Carrier, M.; Planquette, B.; Büller, H.R.; Righini, M.; Huisman, M.V.; Kamphuisen, P.W.
• Is Part Of: Thrombosis research. Issue 152(2017)
• Page Start: 49
• Page End: 51
• Publication Date: 2017-04
• Subjects: D-dimer -- Malignancy -- Pulmonary embolism -- Diagnosis; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2017.02.007
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: Cancer patients frequently present with suspected pulmonary embolism (PE). The D-dimer (DD) test is less useful in excluding PE in cancer patients due to the lower specificity. In the general population, the age-adjusted cutoff for DD combined with a clinical decision rule (CDR) improved specificity in the diagnosis of PE. Objectives: To evaluate the safety and efficacy of the age-adjusted cutoff (defined as age ∗ 10 μg/L in patients > 50 years) combined with a CDR for the exclusion of PE in cancer patients. Methods: We conducted a prospective study to evaluate the age-adjusted cutoff in patients with suspected PE. Here we report a post-hoc analysis on the performance of the age-adjusted cutoff in patients with and without cancer. The primary outcome was the rate of venous thromboembolic events (VTE) during three-month follow-up. Results: Of 3324 patients with suspected PE, 429 (12.9%) patients had cancer. The prevalence of PE was 25.2% in cancer patients and 18% in patients without cancer ( p < 0.001). Among cancer patients with an unlikely CDR, 9.9% had a DD < 500 μg/L as compared with 19.7% using the age-adjusted cutoff. In patients without cancer, these rates were 30.1% and 41.9%. The proportion of cancer patients in whom PE could be excluded by CDR and DD doubled from 6.3% to 12.6%. No VTE occurred during three-month follow-up (failure rate 0.0% (95% CI 0.0–6.9%)). Conclusion: Compared with the conventional cutoff, the age-adjusted D-dimer cutoff doubles the proportion of patients with cancer in whom PE can be safely excluded by CDR and DD without imaging. Highlights: Diagnostic strategies for pulmonary embolism are less efficient in cancer patients. The age-adjusted D-dimer cut-off increased the exclusion rate of pulmonary embolism.