Cancer is one of the conditions associated with a raised level of D-dimer. This causes the specificity of the D-dimer test for suspected venous thrombo-embolism (VTE) to be reduced. This is well known and documented. However, less is known about the prognostic value of an elevated D-dimer. This was investigated by the RIETE group using a multivariate analysis on their extensive database.
ADRIANA VISONÀ The RIETE registry is an abbreviation for “Computerised Registry of Patients with Venous Thromboembolism”. It was set up in 2001 and is a multidisciplinary project involving over 170 hospitals so far, from many countries. The database is co-ordinated in Barcelona by Dr Manuel Monreal and is very extensive. All consecutive patients are recruited if they have acute DVT, PE or SVT confirmed by objective tests. The power of this project gives physicians data from which to compare treatments and results based on previous “real-world” outcomes.
We used the registry to determine the prognostic value of an increased D-dimer at baseline in patients with PE. D-dimer was tested in 2588 patients without cancer compared to 695 patients with cancer. The 3 month results are below:
In the non-cancer patients, the D-dimer levels in the highest quartile versus lower quartiles had a significantly higher rate of fatal PE (2.6% versus 0.9%), fatal bleeding (1.1% versus 0.3%) and all cause death (8.7% versus 4.6%).
In the cancer patients, there were similar rates of fatal PE and fatal bleeding, irrespective of the quartiles compared. However, they had a significantly higher rate of all cause death in the highest quartile (35% versus 24%). Baseline D-dimer failed to predict fatal PE or fatal bleeding in these patients.
The RIETE registry provides a rich source of information for physicians who wish to increase their knowledge on VTE.