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

Marc Righini; Grégoire Le Gal; Sylvain De Lucia; Pierre-Marie Roy; Guy Meyer; Drahomir Aujesky; Henri Bounameaux; Arnaud Perrier

doi:10.1160/TH05-12-0791

Thrombosis and Haemostasis, Table of Contents

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

Authors

Marc Righini

¹Division of Angiology and Hemostasis, Geneva, Switzerland
Grégoire Le Gal

³Department of Internal Medicine and Chest Diseases, EA 3878 (GETBO), Brest University Hospital, Brest, France
Sylvain De Lucia

²Division of General Internal Medicine, Department of Internal Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
Pierre-Marie Roy

⁵Emergency Department, Angers University Hospital, Angers, France
Guy Meyer

⁴Service of Pneumology, Hôpital Européen Georges Pompidou, Paris, France
Drahomir Aujesky

⁶Department of Internal Medicine, University of Lausanne, Switzerland
Henri Bounameaux

¹Division of Angiology and Hemostasis, Geneva, Switzerland
Arnaud Perrier

²Division of General Internal Medicine, Department of Internal Medicine, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland

Abstract

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

Full Text

References

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