Combined use of clinical pre-test probability and D-dimer test in the diagnosis of preoperative deep venous thrombosis in colorectal cancer patients

Mogens Tornby Stender; Jens Brøndum Frøkjær; Tina Sandie Hagedorn Nielsen; Torben Bjerregaard Larsen; Søren Lundbye-Christensen; Henrik Elbrønd; Ole Thorlacius-Ussing

doi:10.1160/TH07-06-0397

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2008; 99(02): 396-400
DOI: 10.1160/TH07-06-0397

Cellular Proteolysis and Oncology

Schattauer GmbH

Combined use of clinical pre-test probability and D-dimer test in the diagnosis of preoperative deep venous thrombosis in colorectal cancer patients

Authors

Mogens Tornby Stender

¹Department of Surgical Gastroenterology A, Aalborg Hospital, Aarhus University Hospital, Denmark
Jens Brøndum Frøkjær

¹Department of Surgical Gastroenterology A, Aalborg Hospital, Aarhus University Hospital, Denmark
Tina Sandie Hagedorn Nielsen

²Department of Radiology, Aalborg Hospital, Aarhus University Hospital, Denmark
Torben Bjerregaard Larsen

³Department of Biochemistry, Pharmacology and Genetics, Odense University Hospital, Denmark
Søren Lundbye-Christensen

⁴Department of Mathematical Sciences, Department of Health Science and Technology, Aalborg University, Denmark
Henrik Elbrønd

¹Department of Surgical Gastroenterology A, Aalborg Hospital, Aarhus University Hospital, Denmark
Ole Thorlacius-Ussing

¹Department of Surgical Gastroenterology A, Aalborg Hospital, Aarhus University Hospital, Denmark

Abstract

Summary

The preoperative prevalence of deep venous thrombosis (DVT) in patients with colorectal cancer may be as high as 8%. In order to minimize the risk of pulmonary embolism, it is important to rule out preoperative DVT. A large study has confirmed that a negative D-dimer test in combination with a low clinical pre-test probability (PTP) can be safely used to rule out the tentative diagnosis of DVT in cancer patients. However, the accuracy in colorectal cancer patients is uncertain. This study assessed the diagnostic accuracy of a quantitative D-dimer assay in combination with the PTP score in ruling out preoperative DVT in colorectal cancer patients admitted for surgery. Preoperative D-dimer test and compression ultrasonography for DVT were performed in 193 consecutive patients with newly diagnosed colorectal cancer. Diagnostic accuracy indices of the D-dimer test were assessed according to the PTP score. The negative predictive value, positive predictive value, sensitivity and specificity were 99% (95% confidence interval (CI), 95–100%), 17% (95% CI, 9–26), 93% (95% CI, 68–100%) and 61% (95% CI, 53–68%), respectively. In conclusion, the combined use of pre-test probability and D-dimer test may be useful in ruling out preoperative DVT in colorectal cancer patients admitted for surgery.

Keywords

Colorectal cancer - D-dimer - diagnostic accuracy - preoperative - venous thromboembolism

Full Text

References

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