Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism

Righini, Marc; Es, Josien van; Exter, Paul L. den; Roy, Pierre‐Marie; Verschuren, Franck; Ghuysen, Alexandre; Rutschmann, Olivier Thierry; Sanchez, Olivier; Jaffrelot, Morgan; Trinh-Duc, Albert; Gall, Catherine Le; Moustafa, Farès; Principe, Alessandra; Houten, Anja A. van; Wolde, Marije ten; Douma, Renée A.; Hazelaar, Germa; Erkens, Petra M. G.; Kralingen, Klaas W. van; Grootenboers, Marco J.J.H.; Durian, Marc; Cheung, Y. Whitney; Meyer, Guy; Bounameaux, Henri; Huisman, Menno V.; Kamphuisen, Pieter Willem; Gal, Grégoire Le

doi:10.1001/jama.2014.2135

Cited by 734 publications

(316 citation statements)

References 29 publications

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“…Thus, a negative D-dimer can be used to exclude DVT in patients with a low clinical probability of DVT. However, it cannot confirm DVT, as D-dimer can be raised in other conditions including malignancy, infection, pregnancy, post-surgery, inflammation/trauma, disseminated intravascular coagulopathy, and renal impairment 1415. An ultrasound is needed to confirm DVT 14…”

Section: How Is It Diagnosed?mentioning

confidence: 99%

Deep vein thrombosis

Stubbs

Mouyis

Thomas

2018

BMJ

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Section: How Is It Diagnosed?mentioning

confidence: 99%

Deep vein thrombosis

Stubbs

Mouyis

Thomas

2018

BMJ

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“…D-dimer measurements are also most useful below this age [30]. Assuming the prevalence of cancer to be 5%, our score shows that if a patient has 3 of 3 possible score points, the probability of active cancer is 53%, while a score of 2 points gives a probability for cancer of 13% (Table 3).…”

Section: Discussionmentioning

confidence: 99%

When to Screen Ischaemic Stroke Patients for Cancer

et al. 2018

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Background and Purpose: Ischemic stroke can be the first manifestation of cancer and it is therefore important to ascertain which stroke patients should be considered for cancer-diagnostic investigations. We aimed to determine the frequency of active cancer in patients with acute ischemic stroke and to compare clinical findings in stroke patients with active cancer to ischemic stroke patients with no history of cancer. Finally, we aimed to develop a predictive and feasible score for clinical use to uncover underlying malignancy. Methods: All ischemic stroke patients admitted to the stroke unit in the Department of Neurology, Haukeland University Hospital were consecutively included in the Norwegian Stroke Research Registry (NORSTROKE). Stroke etiology was determined by the Trial of Org 10172 in Acute Stroke Treatment (TOAST) criteria. Data on cancer diagnoses was obtained from patients’ medical records and the Cancer Registry of Norway. Active cancer was defined as cancer diagnosis, metastasis of known cancer, recurrent cancer or receiving cancer treatment, all within 12 months before or after the index stroke. Based on variables independently associated with active cancer, a predictive score was developed using the area under the receiver operating characteristic (AUC-ROC) curves. Bayes’ theorem was used to calculate post-test probabilities of active cancer. Results: Of the 1,646 ischemic stroke patients included, 82 (5.0%) had active cancer. Increased D-dimer (OR = 1.1, 95% CI: 1.1–1.2, p = <0.001), lower Hb (OR = 0.6, 95% CI: 0.5–0.7, p = <0.001), smoking (OR = 2.2, 95% CI: 1.2–4.3, p = 0.02) and suffering a stroke of undetermined etiology (OR = 1.9, 95% CI: 1.1–3.3, p = 0.03) were factors independently associated with active cancer. These were included in the final predictive score which gave an AUC of 0.73 (95% CI: 0.65–0.81) in patients younger than 75 years of age. Assuming the prevalence of cancer to be 5%, the score shows that if a patient fulfills all 3 score points, the probability of active cancer is 53%. Conclusions: Active cancer was found in 5% of our ischemic stroke patients. We found that a clinical score comprising elevated D-dimer ≥3 mg/L, lower Hb ≤12.0 g/dL and previous or current smoking is feasible for predicting active cancer in ischemic stroke patients.

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“…Nowadays, diagnostic algorithms for detecting PE are sensitive, but overall 3‐month diagnostic failure rate is still not reduced to zero 21, 22, 23. This is, to our best knowledge, the first study to test the effect of statins and antiplatelet drugs on the sensitivity of D‐dimer tests for the diagnosis of acute VTE.…”

Section: Discussionmentioning

confidence: 93%

Clinical effects of antiplatelet drugs and statins on D‐dimer levels

Schol-Gelok

Hulle

Biedermann

et al. 2018

Eur J Clin Investigation

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BackgroundAcute pulmonary embolism may be ruled out by combining nonhigh clinical probability and a normal D‐dimer level. Both antiplatelet drugs and HMG‐CoA reductase inhibitors (statins) have been associated with effects on thrombus formation, potentially influencing D‐dimer levels in this setting, leading to a higher rate of false‐negative tests. Therefore, we determined whether D‐dimer levels in patients with suspected pulmonary embolism are affected by concomitant use of antiplatelet drugs and/or statins and evaluated whether the effect of antiplatelet drugs or statins might affect diagnostic accuracy.Materials and methodsWe performed a posthoc analysis in the YEARS diagnostic study, comparing age‐ and sex‐adjusted D‐dimer levels among users of antiplatelet drugs, statins and nonusers. We then reclassified patients within the YEARS algorithm by developing a model in which we adjusted D‐dimer cut‐offs for statin use and evaluated diagnostic accuracy.ResultsWe included 156 statins users, 147 antiplatelet drugs users and 726 nonusers of either drugs, all with suspected pulmonary embolism. Use of antiplatelet drugs did not have a significant effect, whereas statin use was associated with 15% decrease in D‐dimer levels (95% CI, −28% to −0.6%). An algorithm with lower D‐dimer thresholds in statin users yielded lower specificity (0.42 compared to 0.33) with no difference in false‐negative tests.ConclusionsWe conclude that use of statins but not of antiplatelet agents is associated with a modest decrease in D‐dimer levels. Adjusting D‐dimer cut‐offs for statin use did, however, not result in a safer diagnostic strategy in our cohort.

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Age-Adjusted D-Dimer Cutoff Levels to Rule Out Pulmonary Embolism

Abstract: clinicaltrials.gov Identifier: NCT01134068.

Cited by 734 publications

References 29 publications

Deep vein thrombosis

Deep vein thrombosis

When to Screen Ischaemic Stroke Patients for Cancer

Clinical effects of antiplatelet drugs and statins on D‐dimer levels

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