D-dimer as a predictive biomarker for cancer-associated thrombosis: A prospective cohort study
E. Elsaca a e, J. López b e, A. Valenzuela a e, A. González b e, J. Cerda c e, B. Nervi b d e, A. Aizman a e
a) Department of Internal Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
b) Department of Hematology and Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
c) Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
d) Center for Cancer Prevention and Control (FONDAP-CECAN), Pontificia Universidad Católica de Chile, Santiago, Chile
e) Red de Salud UC CHRISTUS, Santiago, Chile
Highlights
• Cancer-associated thrombosis is common and potentially preventable.
• Khorana Risk Score has limited accuracy in high-risk cancer populations.
• D-dimer was evaluated against existing models in metastatic cancer patients.
• D-dimer showed better VTE prediction (AUC 0.70) than Khorana Score (AUC 0.52).
• D-dimer ≥1062 ng/mL had 100 % sensitivity and 40 % specificity for VTE prediction.
Introduction
Cancer-associated thrombosis (CAT) is a frequent and severe complication in cancer patients, significantly worsening clinical outcomes [1]. While the Khorana Risk Score (KRS) [2] is a widely used tool for identifying high-risk patients, its predictive performance is limited, particularly in patients with advanced or high-risk tumors [3].
More accurate models, such as the modified Vienna CATScore (mVC) [4], integrate biomarkers like D-dimer, which reflects hemostatic activation. Although the mVC has demonstrated superior predictive accuracy [5], its clinical adoption is hindered by the complexity of its calculations. In contrast, D-dimer as a standalone biomarker, has shown promising results in predicting venous thromboembolism (VTE) in select high-risk populations [[6], [7], [8], [9]].
This study aimed to evaluate the predictive value of D-dimer for VTE at six months in ambulatory patients with high-risk, metastatic cancer initiating chemotherapy.