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Diagnosing Deep Vein Thrombosis in Patients with Suspected Symptoms and a Concurrent Malignancy: An Individual Participant Data Meta-Analysis

1University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, the Netherlands, 2McMaster University, Department of Oncology, Hamilton, Canada, 3McMaster University, Department of Medicine, Hamilton, Canada, 4Dalhousie University, Division of Haematology, Halifax, Canada, 5Intermountain Medical Center, Department of Medicine, Murray, United States, 6University of Utah School of Medicine, Department of Internal Medicine, Salt Lake City, United States, 7Maastricht University Medical Center, Department of Internal Medicine, Maastricht, the Netherlands, 8Skane University Hospital, Vascular Center, Malmö, Sweden, 9Academic Medical Center Amsterdam, Department of Medicine, Amsterdam, the Netherlands, 10University Medical Center Utrecht, Van Creveld Clinic, Utrecht, the Netherlands, 11University of Ottawa, Department of Medicine, Ottawa, Canada

Abstract Number: PB2267

Meeting: ISTH 2020 Congress

Theme: Venous Thromboembolism and Cardioembolism » VTE Diagnosis

Background: A previous individual participant data meta-analysis showed that the Wells-rule and D-dimer testing cannot exclude suspected deep vein thrombosis (DVT) in cancer patients.

Aims: The objective of this study was to explore reasons for this reduced diagnostic accuracy and to optimize the diagnostic pathway for cancer patients suspected of DVT.

Methods: Individual patient data from 13 studies in patients with clinically suspected DVT were used to compare DVT prevalence, and the predictive information of individual Wells-rule items, between patients with and without cancer. Subsequently, updating techniques were applied to improve the utility of the Wells-rule and D-dimer testing specifically for cancer patients.

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), while 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, with the exception of ´immobility´ and ´history of DVT´. The newly developed Wells-cancer rule showed a pooled c-statistic 0.80 (95% CI 0.75 to 0.83) and good calibration. However, using this model, still only 4.3% (95% CI 3.0 to 5.7) of the suspected patients with cancer could be identified with a predicted DVT post-test probability of less than 2%.

Conclusions: DVT is present in about 40% of cancer patients with symptoms or signs of DVT. Likely due to this high prevalence, clinical models followed by D-dimer testing fail to rule-out DVT efficiently in patients with cancer. Direct referral for compression ultrasonography appears to be the preferred approach for diagnosis of suspected DVT in patients with cancer.

To cite this abstract in AMA style:

Takada T, van Doorn S, Parpia S, de Wit K, Anderson DR, Stevens SM, Woller SC, ten Cate-Hoek AJ, Elf JL, Kraaijenhagen RA, Schutgens REG, Wells PS, Kearon C, Moons KGM, Geersing G-. Diagnosing Deep Vein Thrombosis in Patients with Suspected Symptoms and a Concurrent Malignancy: An Individual Participant Data Meta-Analysis [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/diagnosing-deep-vein-thrombosis-in-patients-with-suspected-symptoms-and-a-concurrent-malignancy-an-individual-participant-data-meta-analysis/. Accessed September 29, 2023.

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ISTH Congress Abstracts - https://abstracts.isth.org/abstract/diagnosing-deep-vein-thrombosis-in-patients-with-suspected-symptoms-and-a-concurrent-malignancy-an-individual-participant-data-meta-analysis/