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PO-19 Are quantitative D-dimer levels only useful in the diagnosis of venous thrombosis? Predictive role of quantitative D-dimer levels in patients with venous thrombosis
Abstracts / Thrombosis Research 120 Suppl. 2 (2007) S145–S178 Conclusion: Pulmonary tumor emboli continue to cause morbidity and mortality. Although the diagnosis is quite often difficult to establish and effective treatment unavailable, its consideration should help guide patient diagnostic and treatment planning. The pathologic findings in this case can help focus the target of intervention not only for those at bedside but for those bench-side dealing with “seed and soil” hypotheses.
PO-19 Are quantitative D-dimer levels only useful in the diagnosis of venous thrombosis? Predictive role of quantitative D-dimer levels in patients with venous thrombosis S. Paneesha1 *, K. French2 , E. Cheyne2 , P. Kesteven3 , H. Marr3 , A. Borg4 , P. Rose2,4 . 1 Department of Haematology, Heart of England NHS Foundation Trust, Birmingham; 2 Department of Haematology, University Hospital Coventry & Warwickshire, Coventry; 3 Department of Haematology, The Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne; 4 Department of Haematology, Warwick Hospital, Warwick, UK Use of D-dimer levels along with clinical probability scores in the diagnosis of venous thrombosis is well established. Recent focus is to evaluate the predictive value of quantitative D-dimer levels to various clinical outcomes. Six hundred and ninety-nine (M: 360; F: 339) patients with median age 65 yrs and median follow-up 23.2 months were analysed to investigate whether the D-dimer level at presentation in patients with venous thrombosis is a predictor for clinical outcome. Median D-dimer level was 2,300 ng FEU/ml. 17.2% had D-dimer level of >8,000 ng/ml at presentation. 59.3% were aged above 60 years. 55.9% had aboveknee thrombosis, where as 41.8% had below-knee thrombosis and 2.3% had upper-limb thrombosis. Twenty-five percent of patients with above-knee thrombosis had D-dimer level >8,000 ng/ml as compared to 7.1% with below-knee thrombosis (p value <0.001). Recurrent DVT (46.2%), occurrence of malignancy (42.3%) and pulmonary embolism (10.3%) were the events observed. D-dimer >8,000 ng/l at presentation was not a predictor of recurrence of venous thrombosis (p value: 0.143). D-dimer level >8,000 ng/ml, age >60 yrs and above-knee and upper-limb thrombosis were associated with decreased overall survival (p < 0.001 for all the variables) and event-free survival (p < 0.001 for all the variables). D-dimer level >8,000 ng/ml, age >60 yrs and above-knee thrombosis were found to be independent poor prognostic factors for both overall survival and event-free survival by Cox regression analysis. 25.4% had malignancy, of these 29 patients developed malignancy subsequently following venous thrombosis. 6.1% had bowel, 3.9% had breast and prostate, 3.4% had lung, 2.3% had gynecological and 5.8% had miscellaneous malignancy. 29.9% patients with VTE and cancer had D-dimer level >8,000 ng/ml compared to 13.4% patients with VTE without cancer (p < 0.001). Median D-dimer level was 2,200, 3,200, 4,200, 3,100, 3,000, 8,600 and 2,700 respectively for VTE patients with no malignancy, patients with breast, with bowel, prostate, lung, gynecological and miscellaneous cancers (p = 0.0007). Dunn’s multiple comparisons test showed significant difference in the D-dimer level for patients with VTE with no malignancy and VTE patients with gynaecological and bowel & GI cancers (p < 0.05). D-dimer >8,000 ng/ml as compared lower level was associated with poor OS and EFS in patients with malignancy (p < 0.001). Patients aged >60 yrs are associated with malignancy as compared to aged <60 yrs at D-dimer level of <8,000 ng/ml (p = 0.003) and >8,000 ng/ml (p = 0.001) respectively. Elevated D-dimer level at presentation in patients with venous thrombosis is a marker of poor overall and event-free survival. High D-dimer level at presentation in patients with VTE is a predictor for malignancy. Screening for occult malignancy is recommended in patients with VTE above the age of 60 years with D-dimer level >8,000 ng/ml.
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PO-20 Antiphospholipid antibodies spectrum in genital cancer patients with thrombosis in past history A. Makatsaria *, A. Vorobiev, V. Volkova. Moscow Medical Sechenov Academy, Faculty of Obstetrics and Gynaecology, Moscow, Russia Background: Analysis of antiphospholipid antibodies spectrum will improve prophylaxis of recurrent thrombosis in cancer patients. Aim: To determine frequency of occurrence and spectrum of antiphospholipid antibodies in genital cancer patients with foregoing thrombosis. Patients and Methods: 159 women were divided into 4 groups: Group I: 43 women with genital cancer and thrombosis in past history. Group II: 38 women with benign genital tumors and thrombosis in anamnesis. Group III: 40 women with genital cancer without any thrombotic anamnesis. Group IV: 38 women with benign genital tumors. Laboratory tests: APA concentration determination: IgA, IgG, IgM immune-enzyme assay (Orgenteg APA, B2Gp1a, prothrombin, Annexin V). Results: In Group I APA was in 55.8%; B2Gp1a AT in 55.8%; Annexin V AT was in 11.6% and prothrombin AT was in 39.5%. In Group II APA was in 23.6%; B2Gp1a AT in 13.1%; Annexin V AT was in 2.6% and prothrombin AT was in 7.8%. In Group III APA was in 32.5%; B2Gp1a AT in 17.5%; Annexin V AT was in 7.5% and prothrombin AT was in 5.0%. In Group IV APA was in 5.2%; B2Gp1a AT in 2.6%; Annexin V AT was in 2.6% and prothrombin AT was not detected. Conclusions: The high frequency of APA in cancer patients with thrombosis in past history could indicate the role of APA circulation in pathogenesis of thrombophilia. As APS is the most frequent defect of haemostasis which could aggravate thrombophilia status, detection of APA is one of the most important measures in prophylaxis of recurrent thrombosis in cancer patients. PO-21 Clinical significance of revealing combination of genetic forms of thrombophilia and APA in cancer patients with recurrent thrombosis V. Volkova *, A. Vorobiev, A. Makatsaria. Moscow Medical Sechenov Academy, Faculty of Obstetrics and Gynaecology, Moscow, Russia Background: Analysis of combination of APA and genetic thrombophilia will improve prophylaxis of recurrent thrombosis in cancer patient. Aim: To determine frequency of combination of APS and genetic forms of a thrombophilia in genital cancer patients with foregoing thrombosis. Patients and Methods: 159 women were divided into 4 groups: Group I: 43 women with genital cancer and thrombosis in past history. Group II: 38 women with benign genital tumors and thrombosis in anamnesis. Group III: 40 women with genital cancer without any thrombotic anamnesis. Group IV: 38 women with benign genital tumors. Laboratory tests: APA determination: total APA, anti-beta2glycoprotein I (GPI), anti-annexin V, anti-prothrombin (ELISA). Detection of FV Leiden mutation, prothrombin G20210A mutaton, gene PAI-1 G4/G5 polymorphism, gene MTHFR C677T mutation, genes of platelets glycoproteins polymorphism: GP IIb/IIIa, GP Ia/IIa, GPIba, GP ADP. Results: In Group I incidence of genetic form of thrombophilia was 100%, APC 55.8% In Group II genetic thrombophilia was in 100%, combination with APC 2.5%. In Group III genetic thrombophilia was in 42.5%, combination with APC 32.5%. In Group IV genetic thrombophilia was in 20.8, was no combination with APC. Conclusions: Higher frequency of genetic forms of a thrombophilia in combination with APS in cancer patients with recurrent
PO-19 Are quantitative D-dimer levels only useful in the diagnosis of venous thrombosis? Predictive role of quantitative D-dimer levels in patients with venous thrombosis S. Paneesha1 *, K. French2 , E. Cheyne2 , P. Kesteven3 , H. Marr3 , A. Borg4 , P. Rose2,4 . 1 Department of Haematology, Heart of England NHS Foundation Trust, Birmingham; 2 Department of Haematology, University Hospital Coventry & Warwickshire, Coventry; 3 Department of Haematology, The Newcastle upon Tyne Hospitals NHS Trust, Newcastle upon Tyne; 4 Department of Haematology, Warwick Hospital, Warwick, UK Use of D-dimer levels along with clinical probability scores in the diagnosis of venous thrombosis is well established. Recent focus is to evaluate the predictive value of quantitative D-dimer levels to various clinical outcomes. Six hundred and ninety-nine (M: 360; F: 339) patients with median age 65 yrs and median follow-up 23.2 months were analysed to investigate whether the D-dimer level at presentation in patients with venous thrombosis is a predictor for clinical outcome. Median D-dimer level was 2,300 ng FEU/ml. 17.2% had D-dimer level of >8,000 ng/ml at presentation. 59.3% were aged above 60 years. 55.9% had aboveknee thrombosis, where as 41.8% had below-knee thrombosis and 2.3% had upper-limb thrombosis. Twenty-five percent of patients with above-knee thrombosis had D-dimer level >8,000 ng/ml as compared to 7.1% with below-knee thrombosis (p value <0.001). Recurrent DVT (46.2%), occurrence of malignancy (42.3%) and pulmonary embolism (10.3%) were the events observed. D-dimer >8,000 ng/l at presentation was not a predictor of recurrence of venous thrombosis (p value: 0.143). D-dimer level >8,000 ng/ml, age >60 yrs and above-knee and upper-limb thrombosis were associated with decreased overall survival (p < 0.001 for all the variables) and event-free survival (p < 0.001 for all the variables). D-dimer level >8,000 ng/ml, age >60 yrs and above-knee thrombosis were found to be independent poor prognostic factors for both overall survival and event-free survival by Cox regression analysis. 25.4% had malignancy, of these 29 patients developed malignancy subsequently following venous thrombosis. 6.1% had bowel, 3.9% had breast and prostate, 3.4% had lung, 2.3% had gynecological and 5.8% had miscellaneous malignancy. 29.9% patients with VTE and cancer had D-dimer level >8,000 ng/ml compared to 13.4% patients with VTE without cancer (p < 0.001). Median D-dimer level was 2,200, 3,200, 4,200, 3,100, 3,000, 8,600 and 2,700 respectively for VTE patients with no malignancy, patients with breast, with bowel, prostate, lung, gynecological and miscellaneous cancers (p = 0.0007). Dunn’s multiple comparisons test showed significant difference in the D-dimer level for patients with VTE with no malignancy and VTE patients with gynaecological and bowel & GI cancers (p < 0.05). D-dimer >8,000 ng/ml as compared lower level was associated with poor OS and EFS in patients with malignancy (p < 0.001). Patients aged >60 yrs are associated with malignancy as compared to aged <60 yrs at D-dimer level of <8,000 ng/ml (p = 0.003) and >8,000 ng/ml (p = 0.001) respectively. Elevated D-dimer level at presentation in patients with venous thrombosis is a marker of poor overall and event-free survival. High D-dimer level at presentation in patients with VTE is a predictor for malignancy. Screening for occult malignancy is recommended in patients with VTE above the age of 60 years with D-dimer level >8,000 ng/ml.
S151
PO-20 Antiphospholipid antibodies spectrum in genital cancer patients with thrombosis in past history A. Makatsaria *, A. Vorobiev, V. Volkova. Moscow Medical Sechenov Academy, Faculty of Obstetrics and Gynaecology, Moscow, Russia Background: Analysis of antiphospholipid antibodies spectrum will improve prophylaxis of recurrent thrombosis in cancer patients. Aim: To determine frequency of occurrence and spectrum of antiphospholipid antibodies in genital cancer patients with foregoing thrombosis. Patients and Methods: 159 women were divided into 4 groups: Group I: 43 women with genital cancer and thrombosis in past history. Group II: 38 women with benign genital tumors and thrombosis in anamnesis. Group III: 40 women with genital cancer without any thrombotic anamnesis. Group IV: 38 women with benign genital tumors. Laboratory tests: APA concentration determination: IgA, IgG, IgM immune-enzyme assay (Orgenteg APA, B2Gp1a, prothrombin, Annexin V). Results: In Group I APA was in 55.8%; B2Gp1a AT in 55.8%; Annexin V AT was in 11.6% and prothrombin AT was in 39.5%. In Group II APA was in 23.6%; B2Gp1a AT in 13.1%; Annexin V AT was in 2.6% and prothrombin AT was in 7.8%. In Group III APA was in 32.5%; B2Gp1a AT in 17.5%; Annexin V AT was in 7.5% and prothrombin AT was in 5.0%. In Group IV APA was in 5.2%; B2Gp1a AT in 2.6%; Annexin V AT was in 2.6% and prothrombin AT was not detected. Conclusions: The high frequency of APA in cancer patients with thrombosis in past history could indicate the role of APA circulation in pathogenesis of thrombophilia. As APS is the most frequent defect of haemostasis which could aggravate thrombophilia status, detection of APA is one of the most important measures in prophylaxis of recurrent thrombosis in cancer patients. PO-21 Clinical significance of revealing combination of genetic forms of thrombophilia and APA in cancer patients with recurrent thrombosis V. Volkova *, A. Vorobiev, A. Makatsaria. Moscow Medical Sechenov Academy, Faculty of Obstetrics and Gynaecology, Moscow, Russia Background: Analysis of combination of APA and genetic thrombophilia will improve prophylaxis of recurrent thrombosis in cancer patient. Aim: To determine frequency of combination of APS and genetic forms of a thrombophilia in genital cancer patients with foregoing thrombosis. Patients and Methods: 159 women were divided into 4 groups: Group I: 43 women with genital cancer and thrombosis in past history. Group II: 38 women with benign genital tumors and thrombosis in anamnesis. Group III: 40 women with genital cancer without any thrombotic anamnesis. Group IV: 38 women with benign genital tumors. Laboratory tests: APA determination: total APA, anti-beta2glycoprotein I (GPI), anti-annexin V, anti-prothrombin (ELISA). Detection of FV Leiden mutation, prothrombin G20210A mutaton, gene PAI-1 G4/G5 polymorphism, gene MTHFR C677T mutation, genes of platelets glycoproteins polymorphism: GP IIb/IIIa, GP Ia/IIa, GPIba, GP ADP. Results: In Group I incidence of genetic form of thrombophilia was 100%, APC 55.8% In Group II genetic thrombophilia was in 100%, combination with APC 2.5%. In Group III genetic thrombophilia was in 42.5%, combination with APC 32.5%. In Group IV genetic thrombophilia was in 20.8, was no combination with APC. Conclusions: Higher frequency of genetic forms of a thrombophilia in combination with APS in cancer patients with recurrent