No abstract

Significant differences in the clinical profile of venous thromboembolic-related outcomes were observed according to the site of cancer. These findings suggest the development of cancer-specific anticoagulant strategies as an area for further research.

Summary.  Background: A number of variables have been evaluated for risk stratification in patients with acute pulmonary embolism (PE). Whereas increased D‐dimer levels have been associated with mortality at 3 months, its role in predicting short‐term outcome (the period of time during which any therapeutic decision has to be taken) remains unclear. Methods: RIETE is an ongoing, prospective registry of consecutive patients with acute venous thromboembolism. We assessed the prognostic value of D‐dimer levels at baseline, measured with an automated latex agglutination test (IL Test D‐dimer®), on the 15‐day outcome in patients with acute PE. Overall mortality, fatal PE and major bleeding rates were compared by quartile. Results: As of February 2008, 1707 patients with acute PE underwent D‐dimer testing. Of these, 72 patients (4.2%) died during the first 15 days, 11 (0.6%) had recurrent PE, and 29 (1.7%) had major bleeding. Overall mortality increased with increasing D‐dimer levels, from 2.7% in the first quartile (< 1050 ng mL−1) to 7.0% in the fourth quartile (≥ 4200 ng mL−1). The rates of fatal PE and major bleeding also increased. On multivariate analysis, patients with D‐dimer levels in the fourth quartile had an increased risk for overall death (odds ratio, 1.8; 95% CI, 1.1–3.2), fatal PE (odds ratio, 2.0; 95% CI, 1.0–3.8) or major bleeding (odds ratio, 3.2; 95% CI, 1.5–7.0). Conclusions: PE patients with D‐dimer levels in the fourth quartile had an increased incidence of overall death, fatal PE and major bleeding within 15 days both before and after multivariate adjustment.

In patients who present with pulmonary embolism, D-dimer concentration is an independent predictive factor associated with all-cause and pulmonary embolism-related death. D-dimer >or=5000 ng/mL occurs in about one in five patients and is associated with a 2.9-fold increased risk of overall mortality. These results suggest that D-dimer quantification could be a useful biomarker and help determine initial therapies.