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Normal D-dimer levels in cancer patients with radiologic evidence of pulmonary embolism

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Abstract

Accurate and expeditious diagnosis and treatment of pulmonary embolism in cancer patients improves patient outcomes. D-dimer is often used to rule out pulmonary embolism. However, this test is less accurate in cancer patients, and it is unclear whether cancer patients with normal D-dimer levels can present with pulmonary embolism. All consecutive patients who presented to The University of Texas MD Anderson Cancer Center in Houston, Texas, USA, between May 2009 and November 2015 who underwent computed tomography pulmonary angiography and plasma D-dimer level measurement were retrospectively reviewed. Patients with suspected pulmonary embolism and normal D-dimer levels were identified. Among the 8023 cancer patients identified, 1156 (14%) had pulmonary embolism. Only 35 patients with pulmonary embolism (3%) had normal plasma D-dimer levels. Twenty-six of these patients had acute pulmonary embolism and the other nine had subacute or chronic pulmonary embolism. Thirteen of the 26 acute cases were in patients with hematological cancer. Most patients (23/35, 66%) had subsegmental or segmental pulmonary embolism. Only one patient had pulmonary embolism in the main pulmonary arteries. Although it is uncommon (3%), cancer patients with radiologic evidence of pulmonary embolism can present with normal D-dimer levels. Recognizing the possibility of this uncommon occurrence is critical in the decision process for ordering diagnostic tests for evaluation of suspected pulmonary embolism.

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Acknowledgements

The authors acknowledge Erica Goodoff, ELS, for editorial support.

Author information

Author notes

  1. Aiham Qdaisat and Carol C. Wu have contributed equally to this work.

Authors and Affiliations

  1. Department of Emergency Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX, 77030, USA

    Aiham Qdaisat & Sai-Ching Jim Yeung

  2. Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Carol C. Wu

  3. Department of Endocrine Neoplasia and Hormonal Disorders, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Sai-Ching Jim Yeung

Authors
  1. Aiham Qdaisat
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  2. Carol C. Wu
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  3. Sai-Ching Jim Yeung
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Contributions

S-CJY, AQ, and CCW conceived and designed the study and developed the methods. AQ and CCW acquired data from MD Anderson. CCW reviewed questionable diagnostic images. AQ and CCW analyzed and interpreted the data. AQ created the figures and tables. AQ, CCW, and S-CJY drafted the manuscript. All authors reviewed and provided final approval of the manuscript.

Corresponding author

Correspondence to Sai-Ching Jim Yeung.

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Conflict of interest

Dr. Yeung is the principal investigator of an investigator-initiated clinical trial supported by DepoMed and a retrospective clinical study supported by Bristol-Myers Squibb through ARISTA-USA (BMS/Pfizer American Thrombosis Investigator Initiated Research Program). All other authors declare no competing financial or non-financial interests. The corresponding author had full access to all data in the study and had final responsibility for the decision to submit for publication.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

The study was approved by the institutional review boards of MD Anderson; which granted waivers of informed consent.

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Qdaisat, A., Wu, C.C. & Yeung, SC.J. Normal D-dimer levels in cancer patients with radiologic evidence of pulmonary embolism. J Thromb Thrombolysis 48, 174–179 (2019). https://doi.org/10.1007/s11239-019-01863-4

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  • DOI: https://doi.org/10.1007/s11239-019-01863-4

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