Predictive value for thrombosis of pre-chemotherapy D-Dimer in ambulatory cancer patients

Abstract

e20601 Background: Elevated D-Dimer (DD) is related with activated coagulation system. We pretended to assess if high DD is predictive of thrombosis in ambulatory cancer patients. Methods: We prospectively determined DD in plasma specimens from ambulatory cancer patients, without previous thromboembolic events (TE), before chemotherapy initiation. DD was determined with an immunological test in an automated coagulometer (IL D-Dimer test, Instrumentations laboratory). The selected cut-off point for DD was 1.5 x UNL, as it was the nearest point to the median DD. All thromboembolic events were recorded. Results: Between June 2007 and December 2008 eighty four patients were included, 66% with advanced and 34% with early disease. The most frequent tumours were colorectal 31%, breast 27% and genitourinary cancers 30% (12% HR prostate and 28% non prostate cancers). Antiangiogenic drugs were included in 24% of treatments (16% Bevacizumab and 8% Sunitinib). Median ECOG was 1. With a median follow-up of 6.5 months, 12 thromboembolic events were observed (5 PE, 3 DVT and 4 Arterial thrombosis). The following variables were included in the univariate analysis: high DD (>1.5 x UNL), low haemoglobin (Hb <10 mg/dL), high leukocyte, high platelet, high BMI and tumour location. High DD (HR = 6,25, 95% CI: 1,34–29,25; p= 0,02) and low Hb (HR= 6,17, 95% CI: 1,77- 21,53; p=0,004) were associated with increased TE. The high risk group in the Khorana index was also significant (p=0.02). In multivariate analysis both high DD (HR= 5,06, 95%CI: 1,05–24,48; p=0,044) and low Hb (HR=3,77, 95%CI: 1,02–13,97; p=0,047) remained significant. Conclusions: High pre-chemotherapy DD is associated with increased risk of thrombosis in ambulatory cancer patients. No significant financial relationships to disclose.