Fabio Puglisi, MD, PhD; Edda Federico, MD
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Puglisi F., Federico E.; d-Dimer and Venous Thromboembolism. Ann Intern Med. 2004;141:482-483. doi: 10.7326/0003-4819-141-6-200409210-00021
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Published: Ann Intern Med. 2004;141(6):482-483.
TO THE EDITOR:
In the Discussion section of Stein and colleagues' article (1), the authors pointed out that the clinical utility of d-dimer assays may vary among patients with different diseases. In particular, a higher value can be expected when the probability of having DVT or pulmonary embolism is lower, such as in outpatient setting. We agree but believe that another important point should be emphasized.
Deep venous thrombosis and pulmonary embolism are common complications in patients with cancer, and in these patients a d-dimer test is probably of limited diagnostic usefulness. In fact, malignant conditions are often associated with elevated d-dimer levels because of tumor-induced activation of intravascular coagulation (2). Accordingly, different studies evaluating the role of d-dimer in patients with cancer and suspected DVT or pulmonary embolism found that the test had lower specificity and negative predictive value than in patients without cancer (3-5). Clinicians should be cautious about applying the results of Stein and colleagues' systematic review to patients with high probability of elevated d-dimer levels (that is, those in whom the test will have low specificity for DVT or pulmonary embolism), such as patients with cancer.
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