THE ROLE OF D-DIMER AT SCREENING VENOUS THROMBOSIS IN ADVANCED CANCER PATIENTS

Panagiotis Heras (1), Theodosis Andrianopoulos (1), Ioannis Tsiverdis (1), Ilias Georgopoulos (1), Antonios Hatzopoulos (1)

 

(1) Clinic of Internal Medicine, General Hospital of Nafplio, GREECE

Introduction: The incidence of venous thromboembolism (VTE) in advanced cancer patients is up to 30-40 %. D-Dimer is used as screening test for VTE due to its high sensitivity and low cost. But, it is frequently elevated by other causes, like infection or malignancy.

Objectives: To assess D-Dimer utility as screening test for VTE in advanced cancer patients.

Methods: Patients with incurable cancer and swollen leg or other factors (according to Well’s clinical DVT model) underwent D-Dimer test at admission according to our team’s policy. This report is retrospective analysis of patients who were admitted in palliative care ward from July 2010 to December 2014.

Results: Among 125 incurable cancer patients, 103 had Well’s score ≥2 at admission. Among 103 patients, only 5 had normal D-Dimer (<0.5 μg/mL) and the majority (n=79, 76.6 %) was above 2.0 μg/mL. Basically, patients with D-Dimer level ≥2.0 μg/mL should undergo Doppler ultrasonography or contrast-enhanced CT angiography. However, such radiologic workups were done at only 11 patients, since diagnosis of VTE could rarely be beneficial to patients. 7 out of 11 patients (63.6 %) had VTE in radiologic workup. Mean D-Dimer level in VTE patients was 4.9 ± 3.2 μg/mL and 11 ± 7.9 μg/mL in patients without VTE (p=0.070). All of the patients with VTE had D-Dimer level of >2.0 μg/mL.

Conclusions: In advanced cancer patients, D-Dimer may lack its screening value for VTE. Patients without VTE also have high level of D-Dimer. A novel cost-effective tool is necessary for screening VTE.