TY - JOUR
T1 - Diagnosing deep vein thrombosis in cancer patients with suspected symptoms
T2 - an individual participant data meta-analysis
AU - Takada, Toshihiko
AU - van Doorn, Sander
AU - Parpia, Sameer
AU - de Wit, Kerstin
AU - Anderson, David R
AU - Stevens, Scott M
AU - Woller, Scott C
AU - Ten Cate-Hoek, Arina J
AU - Elf, Johan L
AU - Kraaijenhagen, Roderik A
AU - Schutgens, Roger E G
AU - Wells, Phil S
AU - Kearon, Clive
AU - Moons, Karel G M
AU - Geersing, Geert-Jan
N1 - Funding Information:
Dr. Takada is supported by the Uehara Memorial Foundation. Dr. Kearon is supported by the Jack Hirsh Professorship in Thromboembolism and is an investigator of the CanVECTOR Network and the Thrombosis and Atherosclerosis Research Institute, Canada. Dr. Geersing is supported by a Veni and Vidi grant from the Netherlands Organization of Health Research and Development. The remaining authors have disclosed no conflicts of interest.
Publisher Copyright:
© 2020 International Society on Thrombosis and Haemostasis
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/9
Y1 - 2020/9
N2 - BACKGROUND: A previous individual participant data (IPD) meta-analysis showed that the Wells rule and D-dimer testing cannot exclude suspected deep vein thrombosis (DVT) in cancer patients.OBJECTIVES: To explore reasons for this reduced diagnostic accuracy and to optimize the diagnostic pathway for cancer patients suspected of DVT.PATIENTS AND METHODS: Using IPD from 13 studies in patients with suspected DVT, DVT prevalence and the predictive value of the Wells rule items and D-dimer testing were compared between patients with and without cancer. Next, we developed a prediction model with five variables selected from all available diagnostic predictors.RESULTS: Among the 10 002 suspected DVT patients, there were 834 patients with cancer. The median prevalence of DVT in these patients with cancer was 37.5% (interquartile range [IQR], 30.8-45.5), whereas it was 15.1% (IQR, 11.5-16.7) in patients without cancer. Diagnostic performance of individual Wells rule items and D-dimer testing was similar across patients with and without cancer, except "immobility" and "history of DVT." The newly developed rule showed a pooled c-statistic 0.80 (95% confidence interval [CI], 0.75-0.83) and good calibration. However, using this model, still only 4.3% (95% CI, 3.0-5.7) of the suspected patients with cancer could be identified with a predicted DVT posttest probability of <2%.CONCLUSIONS: Likely because of the high prevalence of DVT, clinical models followed by D-dimer testing fail to rule out DVT efficiently in cancer patients suspected of DVT. Direct referral for compression ultrasonography appears to be the preferred approach for diagnosis of suspected DVT in cancer patients.
AB - BACKGROUND: A previous individual participant data (IPD) meta-analysis showed that the Wells rule and D-dimer testing cannot exclude suspected deep vein thrombosis (DVT) in cancer patients.OBJECTIVES: To explore reasons for this reduced diagnostic accuracy and to optimize the diagnostic pathway for cancer patients suspected of DVT.PATIENTS AND METHODS: Using IPD from 13 studies in patients with suspected DVT, DVT prevalence and the predictive value of the Wells rule items and D-dimer testing were compared between patients with and without cancer. Next, we developed a prediction model with five variables selected from all available diagnostic predictors.RESULTS: Among the 10 002 suspected DVT patients, there were 834 patients with cancer. The median prevalence of DVT in these patients with cancer was 37.5% (interquartile range [IQR], 30.8-45.5), whereas it was 15.1% (IQR, 11.5-16.7) in patients without cancer. Diagnostic performance of individual Wells rule items and D-dimer testing was similar across patients with and without cancer, except "immobility" and "history of DVT." The newly developed rule showed a pooled c-statistic 0.80 (95% confidence interval [CI], 0.75-0.83) and good calibration. However, using this model, still only 4.3% (95% CI, 3.0-5.7) of the suspected patients with cancer could be identified with a predicted DVT posttest probability of <2%.CONCLUSIONS: Likely because of the high prevalence of DVT, clinical models followed by D-dimer testing fail to rule out DVT efficiently in cancer patients suspected of DVT. Direct referral for compression ultrasonography appears to be the preferred approach for diagnosis of suspected DVT in cancer patients.
KW - D-dimer
KW - clinical decision-making
KW - decision support techniques
KW - neoplasms
KW - venous thrombosis
UR - https://www.scopus.com/pages/publications/85087614176
U2 - 10.1111/jth.14900
DO - 10.1111/jth.14900
M3 - Article
C2 - 32433797
SN - 1538-7836
VL - 18
SP - 2245
EP - 2252
JO - Journal of thrombosis and haemostasis : JTH
JF - Journal of thrombosis and haemostasis : JTH
IS - 9
ER -