• Jennifer Gotta, Leon D Gruenewald, Katrin Eichler, Simon S Martin, Scherwin Mahmoudi, Christian Booz, Teodora Biciusca, Philipp Reschke, Simon Bernatz, Daniel Pinto Dos Santos, Jan-Erik Scholtz, Leona S Alizadeh, Nour-EldinNour-Eldin ANAGoethe University Hospital Frankfurt, Frankfurt am Main, Germany., Renate M Hammerstingl, Tatjana Gruber-Rouh, Christoph Mader, Stefan E Hardt, Christof M Sommer, Giuseppe Bucolo, Tommaso D'Angelo, Melis Onay, Fabian Finkelmeier, David M Leistner, Thomas J Vogl, Evangelos Giannitsis, and Vitali Koch.
• Goethe University Hospital Frankfurt, Frankfurt am Main, Germany.
• Eur. J. Clin. Invest. 2023 Oct 1; 53 (10): e14060e14060.

BackgroundCancer 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.MethodsIn 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.ResultsD-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.ConclusionsStandardizing 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.© 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.

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