Unveiling the diagnostic enigma of D-dimer testing in cancer patients : Current evidence and areas of application
© 2023 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation..
BACKGROUND: Cancer is a well-known risk factor for venous thromboembolism (VTE). A combined strategy of D-dimer testing and clinical pre-test probability is usually used to exclude VTE. However, its effectiveness is diminished in cancer patients due to reduced specificity, ultimately leading to a decreased clinical utility. This review article seeks to provide a comprehensive summary of how to interpret D-dimer testing in cancer patients.
METHODS: In accordance with PRISMA standards, literature pertaining to the diagnostic and prognostic significance of D-dimer testing in cancer patients was carefully chosen from reputable sources such as PubMed and the Cochrane databases.
RESULTS: D-dimers have not only a diagnostic value in ruling out VTE but can also serve as an aid for rule-in if their values exceed 10-times the upper limit of normal. This threshold allows a diagnosis of VTE in cancer patients with a positive predictive value of more than 80%. Moreover, elevated D-dimers carry important prognostic information and are associated with VTE reoccurrence. A gradual increase in risk for all-cause death suggests that VTE is also an indicator of biologically more aggressive cancer types and advanced cancer stages. Considering the lack of standardization for D-dimer assays, it is essential for clinicians to carefully consider the variations in assay performance and the specific test characteristics of their institution.
CONCLUSIONS: Standardizing D-dimer assays and developing modified pretest probability models specifically for cancer patients, along with adjusted cut-off values for D-dimer testing, could significantly enhance the accuracy and effectiveness of VTE diagnosis in this population.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:53 |
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| Enthalten in: |
European journal of clinical investigation - 53(2023), 10 vom: 19. Okt., Seite e14060 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Gotta, Jennifer [VerfasserIn] |
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| Links: |
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| Themen: |
Cancer |
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| Anmerkungen: |
Date Completed 04.10.2023 Date Revised 04.10.2023 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/eci.14060 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM359105351 |
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| 100 | 1 | |a Gotta, Jennifer |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Unveiling the diagnostic enigma of D-dimer testing in cancer patients |b Current evidence and areas of application |
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| 500 | |a Date Revised 04.10.2023 | ||
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| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2023 The Authors. European Journal of Clinical Investigation published by John Wiley & Sons Ltd on behalf of Stichting European Society for Clinical Investigation Journal Foundation. | ||
| 520 | |a BACKGROUND: Cancer is a well-known risk factor for venous thromboembolism (VTE). A combined strategy of D-dimer testing and clinical pre-test probability is usually used to exclude VTE. However, its effectiveness is diminished in cancer patients due to reduced specificity, ultimately leading to a decreased clinical utility. This review article seeks to provide a comprehensive summary of how to interpret D-dimer testing in cancer patients | ||
| 520 | |a METHODS: In accordance with PRISMA standards, literature pertaining to the diagnostic and prognostic significance of D-dimer testing in cancer patients was carefully chosen from reputable sources such as PubMed and the Cochrane databases | ||
| 520 | |a RESULTS: D-dimers have not only a diagnostic value in ruling out VTE but can also serve as an aid for rule-in if their values exceed 10-times the upper limit of normal. This threshold allows a diagnosis of VTE in cancer patients with a positive predictive value of more than 80%. Moreover, elevated D-dimers carry important prognostic information and are associated with VTE reoccurrence. A gradual increase in risk for all-cause death suggests that VTE is also an indicator of biologically more aggressive cancer types and advanced cancer stages. Considering the lack of standardization for D-dimer assays, it is essential for clinicians to carefully consider the variations in assay performance and the specific test characteristics of their institution | ||
| 520 | |a CONCLUSIONS: Standardizing D-dimer assays and developing modified pretest probability models specifically for cancer patients, along with adjusted cut-off values for D-dimer testing, could significantly enhance the accuracy and effectiveness of VTE diagnosis in this population | ||
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| 650 | 4 | |a deep vein thrombosis | |
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| 700 | 1 | |a Eichler, Katrin |e verfasserin |4 aut | |
| 700 | 1 | |a Martin, Simon S |e verfasserin |4 aut | |
| 700 | 1 | |a Mahmoudi, Scherwin |e verfasserin |4 aut | |
| 700 | 1 | |a Booz, Christian |e verfasserin |4 aut | |
| 700 | 1 | |a Biciusca, Teodora |e verfasserin |4 aut | |
| 700 | 1 | |a Reschke, Philipp |e verfasserin |4 aut | |
| 700 | 1 | |a Bernatz, Simon |e verfasserin |4 aut | |
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