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Thromb Haemost 2006; 95(04): 715-719
DOI: 10.1160/TH05-12-0791
Cellular Proteolysis and Oncology
Schattauer GmbH

Clinical usefulness of D-dimer testing in cancer patients with suspected pulmonary embolism

Marc Righini
1   Division of Angiology and Hemostasis, Geneva, Switzerland
,
Grégoire Le Gal
3   Department of Internal Medicine and Chest Diseases, EA 3878 (GETBO), Brest University Hospital, Brest, France
,
Sylvain De Lucia
2   Division of General Internal Medicine, Department of Internal Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
,
Pierre-Marie Roy
5   Emergency Department, Angers University Hospital, Angers, France
,
Guy Meyer
4   Service of Pneumology, Hôpital Européen Georges Pompidou, Paris, France
,
Drahomir Aujesky
6   Department of Internal Medicine, University of Lausanne, Switzerland
,
Henri Bounameaux
1   Division of Angiology and Hemostasis, Geneva, Switzerland
,
Arnaud Perrier
2   Division of General Internal Medicine, Department of Internal Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
› Author AffiliationsFinancial support: The two studies that were used in this work were supported by a grant from the Hirsch Fund of the University of Geneva, a grant (32–61773.00) from the Swiss National Research Foundation; grants 97/4-T10 and 00/4-T9 from the Royal College of Physicians and Surgeons, Canada; a grant from La Fondation Québécoise pour le Progrès de la Médecine Interne and Les Internistes et Rhumatologues Associés de l’Hôpital du Sacré-Cœur, Montreal, Canada; and grant 2001/021 from the Direction of Clinical Research of the Angers University Hospital.
Further Information

Publication History

Received 07 December 2005

Accepted after revision 27 February 2006

Publication Date:
30 November 2017 (online)

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Summary

Limited data are available about the diagnostic value of D-dimer testing in cancer patients with clinically suspected pulmonary embolism (PE).Therefore, we evaluated i) the safety and clinical usefulness of an ELISA D-dimer test to rule out PE in cancer patients compared with non-cancer patients and ii) whether adopting a higher D-dimer cut-off value might increase the usefulness of D-dimer in cancer patients. We analysed data from two outcome studies which enrolled 1,721 consecutive patients presenting in the emergency department with clinically suspected PE. Presence of an active malignancy was abstracted from the database. All patients underwent a sequential diagnostic work-up including an ELISA D-dimer test and a 3-month followup. Sensitivity and predictive value (NPV) were 100% in both cancer and non-cancer patients. PE was ruled out by a negative D-dimer test in 494/1,554 (32%) patients without cancer, and in 18/164 (11%) patients witha malignancy. At cut-off values varying from 500 to 900 µg/l, the sensitivity was unchanged (100%, 95% CI: 93% to 100%) and the specificity increased from 16% (95% CI:11% to 24%) to 30% (95% CI:22% to 39%).The 3-month thromboembolic risk was 0% (95 % CI: 0% to 18%) in cancer patients witha negative D-dimer test. ELISA D-dimer appears safe to rule out pulmonary embolism in cancer patients but it is negative in only one of ten patients at the usual cut-off value. Increasing the cut-off value of D-dimer in cancer patients might increase the test’s clinical usefulness.

Keywords

Cancer - cut-off - D-dimer - diagnosis - pulmonary embolism
 

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