D-Dimer beyond Diagnosis of Pulmonary Embolism: Its Implication for Long-Term Prognosis in Cardio-Oncology Era

Venous thromboembolism (VTE) is a common comorbidity of cancer, often referred to as cancer-associated thrombosis (CAT). Even though its prevalence has been increasing, its clinical picture has not been thoroughly investigated. In this single-center retrospective observational study, 259 patients wh...

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Published in:Journal of personalized medicine 2023-01, Vol.13 (2), p.226
Main Authors: Himeno, Masafumi, Nagatomo, Yuji, Miyauchi, Akira, Sakamoto, Aimi, Kiyose, Keita, Yukino-Iwashita, Midori, Kawai, Akane, Naganuma, Tsukasa, Maekawara, Satonori, Naito, Ayami, Kagami, Kazuki, Yumita, Yusuke, Yasuda, Risako, Toya, Takumi, Ikegami, Yukinori, Masaki, Nobuyuki, Adachi, Takeshi
Format: Article
Language:English
Subjects:
Anticoagulants
Blood clots
Cancer
Clinical outcomes
Comorbidity
Computed tomography
Diagnosis
Embolism
Health aspects
Hypertension
Japan
Laboratories
Malignancy
Medical prognosis
Medical research
Medicine, Experimental
Mortality
Patients
Precision medicine
Prognosis
Pulmonary embolism
Pulmonary embolisms
Regression analysis
Statistical analysis
Thromboembolism
Thrombosis
Tumors
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Summary:Venous thromboembolism (VTE) is a common comorbidity of cancer, often referred to as cancer-associated thrombosis (CAT). Even though its prevalence has been increasing, its clinical picture has not been thoroughly investigated. In this single-center retrospective observational study, 259 patients who were treated for pulmonary embolism (PE) between January 2015 and December 2020 were available for analysis. The patients were divided by the presence or absence of concomitant malignancy, and those with malignancy (N = 120, 46%) were further classified into active (N = 40, 15%) and inactive groups according to the treatment status of malignancy. In patients with malignancy, PE was more often diagnosed incidentally by computed tomography or D-dimer testing, and the proportion of massive PE was lower. Although D-dimer levels overall decreased after the initiation of anticoagulation therapy, concomitant malignancy was independently associated with higher D-dimer at discharge despite the lower severity of PE at onset. The patients with malignancy had a poor prognosis during post-discharge follow-up. Active malignancy was independently associated with major adverse cardiovascular events (MACE) and major bleeding. D-dimer at discharge was an independent predictor of mortality even after adjustment for malignancy. This study's findings suggest that CAT-PE patients might have hypercoagulable states, which can potentially lead to a poorer prognosis.
ISSN:2075-4426
2075-4426
DOI:10.3390/jpm13020226