In proven deep vein thrombosis, a low positive D-Dimer score is a strong negative predictor for associated malignancy

Summary

D-Dimer measurements are being increasingly used for negative prediction of deep vein thrombosis (DVT). At our institution, clinical score, D-Dimer assay, plethysmography and, if necessary, Doppler ultrasound are used to secure the diagnosis. We collected the data from 100 consecutive patients proven to have DVT. We examined their medical case notes at diagnosis for concurrent clinical conditions and one year later to look for documented evidence of malignancy. Twenty-two of the 66 patients with D-Dimers greater than 1000 ng/ml were diagnosed with a cancer compared with only 2 of the 34 patients with a presenting D-Dimer score of less than 1000 ng/ml. We propose that a D-Dimer score of less than 1000 ng/ml in proven DVT is a strong negative predictor for malignancy (p = 0.0025).

Keywords

D-Dimers - malignancy - deep vein thrombosis (DVT)

• References

• 1 Wells PS, Anderson DR, Rodger M. et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med 2003; 349: 1227-35.
• 2 Van der Graaf F, Van der Borne H, Van der Kolk M. et al. Exclusion of deep venous thrombosis with D-dimer testing: comparison of 13 D-dimer methods in 99 outpatients suspected of deep venous thrombosis using venography as reference standard. Thromb Haemost 2000; 83: 191-8.
• 3 Wells PS, Hirsh J, Anderson DR. et al. Accuracy of clinical assessment of deep-vein thrombosis. Lancet 1995; 345: 1326-30.
• 4 Sorensen HT, Mellemkjaer L, Olsen JH. et al. Prognosis of cancers associated with venous thrombosis. N Engl J Med 2000; 343: 1846-50.
• 5 Phlegmasia alba dolens. In: Trousseau A. Lectures on clinical medicine, delivered at the Hôtel-Dieu, Paris. Cormack JR. trans. London: New Sydenham Society; 1872: 281-95.
• 6 Prandoni P, Lensing AWA, Büller HR. et al. Deep-vein thrombosis and the incidence of subsequent symptomatic cancer. N Engl J Med 1992; 327: 1128-33.
• 7 Aderka D, Brown A, Zelikovski A. et al. Idiopathic deep vein thrombosis in an apparently healthy patient as a premonitory sign of occult cancer. Cancer 1986; 57: 1846-49.
• 8 Monreal M, Lafoz E, Casals A. et al. Occult cancer in patients with deep vein thrombosis : a systematic approach. Cancer 1991; 67: 541-5.
• 9 Sorensen HT, Mellemkjaer L, Olsen JH. et al. Prognosis of cancers associated with venous thrombosis. N Engl J Med 2000; 343: 1846-50.
• 10 Hoffman R. Cancer and thrombosis. Blood Rev 2001; 61-67.