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Performance of the age-adjusted cut-off for D-dimer in patients with cancer and suspected pulmonary embolism.
Thromb Res. 2017 Apr; 152:49-51.TR

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∗10μg/L in patients >50years) 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 <500μg/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.

Authors+Show Affiliations

Department of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands. Electronic address: i.t.wilts@umcg.nl.Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. Electronic address: gregoire.legal@chu-brest.fr.Dept. of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: p.l.den_exter@lumc.nl.Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: j.vanes@olvg.nl.Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada. Electronic address: mcarrier@toh.on.ca.Service de pneumologie et de soins intensifs, Hôpital Européen Georges Pompidou, Paris, France. Electronic address: benjamin.planquette@aphp.fr.Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: h.r.buller@amc.nl.Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland. Electronic address: marc.righini@hcuge.ch.Dept. of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, The Netherlands. Electronic address: m.v.huisman@lumc.nl.Department of Vascular Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands; Tergooi Hospital, Hilversum, The Netherlands. Electronic address: p.w.kamphuisen@umcg.nl.

Pub Type(s)

Clinical Trial
Letter

Language

eng

PubMed ID

28226257

Citation

Wilts, I T., et al. "Performance of the Age-adjusted Cut-off for D-dimer in Patients With Cancer and Suspected Pulmonary Embolism." Thrombosis Research, vol. 152, 2017, pp. 49-51.
Wilts IT, Le Gal G, Den Exter PL, et al. Performance of the age-adjusted cut-off for D-dimer in patients with cancer and suspected pulmonary embolism. Thromb Res. 2017;152:49-51.
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. (2017). Performance of the age-adjusted cut-off for D-dimer in patients with cancer and suspected pulmonary embolism. Thrombosis Research, 152, 49-51. https://doi.org/10.1016/j.thromres.2017.02.007
Wilts IT, et al. Performance of the Age-adjusted Cut-off for D-dimer in Patients With Cancer and Suspected Pulmonary Embolism. Thromb Res. 2017;152:49-51. PubMed PMID: 28226257.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Performance of the age-adjusted cut-off for D-dimer in patients with cancer and suspected pulmonary embolism. AU - Wilts,I T, AU - Le Gal,G, AU - Den Exter,P L, AU - Van Es,J, AU - Carrier,M, AU - Planquette,B, AU - Büller,H R, AU - Righini,M, AU - Huisman,M V, AU - Kamphuisen,P W, Y1 - 2017/02/13/ PY - 2016/10/31/received PY - 2017/02/07/revised PY - 2017/02/10/accepted PY - 2017/2/23/pubmed PY - 2017/4/28/medline PY - 2017/2/23/entrez KW - D-dimer KW - Diagnosis KW - Malignancy KW - Pulmonary embolism SP - 49 EP - 51 JF - Thrombosis research JO - Thromb Res VL - 152 N2 - 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∗10μg/L in patients >50years) 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 <500μg/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. SN - 1879-2472 UR - https://www.unboundmedicine.com/medline/citation/28226257/Performance_of_the_age_adjusted_cut_off_for_D_dimer_in_patients_with_cancer_and_suspected_pulmonary_embolism_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0049-3848(17)30031-2 DB - PRIME DP - Unbound Medicine ER -