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

2006 ◽  
Vol 95 (04) ◽  
pp. 715-719 ◽  
Author(s):  
Grégoire Le Gal ◽  
Sylvain De Lucia ◽  
Pierre-Marie Roy ◽  
Guy Meyer ◽  
Drahomir Aujesky ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cancer Patients ◽  
Diagnostic Value ◽  
Clinical Usefulness ◽  
Limited Data ◽  
Suspected Pulmonary Embolism ◽  
Diagnostic Work ◽  
Work Up ◽  
D Dimer ◽  
Rule Out

SummaryLimited 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.

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

2003 ◽  
Vol 1 ◽  
pp. P1403-P1403
Author(s):  
A. Perrier ◽  
S. De Lucia ◽  
D. Aujesky ◽  
P. M. Roy ◽  
J. Cornuz ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cancer Patients ◽  
Clinical Usefulness ◽  
Suspected Pulmonary Embolism ◽  
D Dimer

Ruling out clinically suspected pulmonary embolism by assessment of clinical probability and D-dimer levels: a management study

2003 ◽  
Vol 89 (01) ◽  
pp. 97-103 ◽  
Author(s):  
Johan Lutisan ◽  
Marinus Marwijk Kooy ◽  
Bart Kuipers ◽  
Ad Oostdijk ◽  
Jef van der Leur ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Probability Assessment ◽  
Suspected Pulmonary Embolism ◽  
Thromboembolic Risk ◽  
Management Study ◽  
Entire Cohort ◽  
Clinical Probability ◽  
Diagnostic Work ◽  
Work Up ◽  
D Dimer

SummaryD-dimer test combined with clinical probability assessment has been proposed as the first step in the diagnostic work-up of patients with suspected pulmonary embolism (PE). In a prospective management study we investigated the safety and efficiency of excluding PE by a normal D-dimer combined with a low or moderate clinical probability. Of the 202 study patients this combination ruled out PE in 64 (32%) patients. The 3-month thromboembolic risk in these patients was 0% (95% CI, 0.0-5.6%).The prevalence of PE in the entire cohort was 29% (59 patients), whereas in the low, moderate and high clinical probability groups this was 25%, 26% and 50%, respectively. We conclude that ruling out suspected PE by a normal D-dimer combined with a low or moderate clinical probability appears to be a safe and efficient strategy. The accuracy of the clinical probability assessment is modest.

Combined measurement of factor XIII and D-dimer is helpful for differential diagnosis in patients with suspected pulmonary embolism

2017 ◽  
Vol 55 (12) ◽  
Author(s):  
Ning Tang ◽  
Ziyong Sun ◽  
Dengju Li ◽  
Jun Yang ◽  
Shiyu Yin ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Pulmonary Embolism ◽  
Factor Xiii ◽  
Coagulation Factor ◽  
Suspected Pulmonary Embolism ◽  
Coronary Syndrome ◽  
Single Center Study ◽  
Wells Score ◽  
D Dimer ◽  
Rule Out

AbstractBackground:D-dimer has been used to rule out pulmonary embolism (PE). Based on previous reports of decreased concentrations of coagulation factor XIII (FXIII) in venous thromboembolism, and no change in FXIII concentration in patients with acute cardiovascular disease, we evaluated the benefit of simultaneously measuring D-dimer and FXIII concentrations for diagnosing PE.Methods:In this prospective single-center study, we enrolled 209 patients initially suspected of having PE, and measured their D-dimer and FXIII concentrations. Forty-one patients were diagnosed with PE and 168 with other final diagnoses, including acute coronary syndrome (ACS); aortic dissection (AD); spontaneous pneumothorax (SP); other respiratory, heart, digestive and nervous diseases; and uncertain diagnoses.Results:Patients with PE had significantly higher D-dimer and lower FXIII concentrations than did patients without PE. Combined D-dimer and FXIII measurements provided a higher positive predictive value (76.6%) for PE than single tests, especially in patients with Wells score >4.0 (89.3%). Specifically, patients with AD or ACS showed higher FXIII concentrations and mean platelet volumes than did patients with PE or SP, and patients with PE and AD had higher D-dimer concentrations than did other patients. At the thresholds of 69.0% for FXIII and 1.10 μg/mL for D-dimer, 123/151 patients (81.5%) with serious diseases (PE, AD, ACS and SP) were correctly distinguished.Conclusions:Combined measurement of D-dimer and FXIII helps distinguish PE from serious diseases with similar symptoms and appears to relate to increased FXIII release from active platelets in cardiovascular disease.

scholarly journals Clinical applicability of D-dimer assay in the diagnosis of pulmonary embolism reduces with aging

2007 ◽  
Vol 1 (4) ◽  
pp. 153-164
Author(s):  
Luca Masotti ◽  
Giancarlo Landini ◽  
Fabio Antonelli ◽  
Elio Venturini ◽  
Roberto Cappelli ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Elderly Patients ◽  
Case Reports ◽  
High Morbidity ◽  
Clinical Probability ◽  
Clinical Applicability ◽  
Diagnostic Management ◽  
Diagnostic Work ◽  
Work Up ◽  
D Dimer

Despite modern algorithms have been proposed for diagnosis of pulmonary embolism (PE), it remains understimed and often missed in clinical practice, especially in elderly patients, resulting in high morbidity and mortality when early and correctly untreated. One of the main controversial issue is represented by the role and applicability of D-dimer in the diagnostic work up of geriatric patients. Most recent guidelines in young-adult patients suggest to perform D-dimer assay by ELISA or immunoturbidimetric methods only in non high pre-test clinical probability (PTP) patients; in these patients negative D-dimer can safely rule out the diagnosis of PE. This strategy is safe also in elderly patients; however the percentage of patients with non high PTP and negative D-dimer reduces progressively with age, making difficult its clinical applicability. The Authors, starting from two case reports, up date the diagnostic management of PE underling the limitations of D-dimer assay in elderly patients.

scholarly journals Clinical Usefulness of D-Dimer Depending on Clinical Probability and Cutoff Value in Outpatients With Suspected Pulmonary Embolism

2004 ◽  
Vol 164 (22) ◽  
pp. 2483 ◽  
Author(s):  
Marc Righini ◽  
Drahomir Aujesky ◽  
Pierre-Marie Roy ◽  
Jacques Cornuz ◽  
Philippe de Moerloose ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Clinical Usefulness ◽  
Suspected Pulmonary Embolism ◽  
Cutoff Value ◽  
Clinical Probability ◽  
D Dimer

scholarly journals Non-invasive diagnostic work-up of patients with clinically suspected pulmonary embolism; results of a management study

2004 ◽  
Vol 2 (7) ◽  
pp. 1110-1117 ◽  
Author(s):  
M. Ten Wolde ◽  
P. J. Hagen ◽  
M. R. Macgillavry ◽  
I. J. Pollen ◽  
A. T. A. Mairuhu ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Suspected Pulmonary Embolism ◽  
Management Study ◽  
Non Invasive ◽  
Diagnostic Work ◽  
Work Up ◽  
Diagnostic Work Up

scholarly journals Different D-dimer algorithms to rule out pulmonary embolism in patients with cancer: a comparative study

2021 ◽  
Vol 10 (Supplement_1) ◽  
Author(s):  
BV Silva ◽  
C Mendonca ◽  
N Cunha ◽  
P Silverio Antonio ◽  
T Rodrigues ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Cancer Patients ◽  
Clinical Decision ◽  
Pulmonary Angiography ◽  
Lower Sensitivity ◽  
Vein Thrombosis ◽  
Patients With Cancer ◽  
D Dimer ◽  
Active Cancer ◽  
Rule Out

Abstract Funding Acknowledgements Type of funding sources: None. Background Pulmonary embolism (PE) is more prevalent in patients with cancer. D-dimers are a less useful test in such patients due to less specificity. Several algorithms have been developed as an alternative to the fixed d-dimer cutoff,  aiming to avoid the excessive use of computed tomography pulmonary angiography (CTPA), but it is not clear which is the most accurate algorithm in PE patients with cancer. Objective To compare the efficacy of 4 algorithms to rule out pulmonary embolism (fixed Ddimer cutoff, age-adjusted, YEARS and PEGed) in patients with active cancer. Methods Retrospective study of consecutive outpatients who presented to the emergency department and underwent CTPA for PE suspicion from April 2019 to February 2020. The clinical-decision algorithms were retrospectively applied. In fixed and age-adjusted cutoffs, high probability patients are directly selected for CTPA and the others perform CTPA if DDimer ≥500µg/L or age x10 µg/L within patients over 50 years, respectively. YEARS includes 3 items (signs of deep vein thrombosis, haemoptysis and whether PE is the most likely diagnosis): patients without any YEARS items and Ddimer ≥1000ng/mL or with ≥1 items and Ddimer 500ng/mL perform CTPA. In the PEGeD, patients with high clinical probability or with intermediate and Ddimer >500µg/L or low probability and Ddimer >1000 µg/L are selected for CTPA. Results Of 409 patients with suspected PE, 87 patients (21,3%) had cancer. The prevalence of PE was 38% in cancer patients and 35% in patients without cancer (p > 0.05). Age-adjusted cut-off, compared to the conventional cutoff, had an AUC significantly higher (0.68 vs 0.61, p = 0.005). Despite both having 100% sensitivity, age-adjusted cutoff had a significant higher specificity compared to conventional cut-off (44% vs 35%, p < 0.05). Both YEARS and PEGED algorithms had significantly lower sensitivity (p = 0.003 and p = 0.002, respectively) and higher specificity (p < 0.001, for both) compared to conventional cutoff in patients with active cancer. The AUC of these two algorithms was not significantly different compared to conventional cutoff (p = 0.08 and p = 0.78, respectively). Conclusion Considering our results, age-adjusted cut-off seems to be the most accurate algorithm to rule out pulmonary embolism in active cancer patients. Sen(%)Spec(%)Conventional10022Age-adjusted10035YEARS9144PEGED9130Abstract Figure. AUC of four algorithms

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