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[Polycythemia vera and D-dimer-negative thromboembolism].

Jörg Bäsecke1, Imme Conradi, Carsten P Bramlage

  • 1Abteilung Hämatologie und Onkologie, Universitätsklinikum, Göttingen. jbaesec@gwdg.de

Medizinische Klinik (Munich, Germany : 1983)
|October 13, 2005
PubMed
Summary

Polycythemia vera patients experiencing thromboembolic events may have negative D-dimer results. Early diagnosis and prophylactic low-dose aspirin are recommended for these high-risk individuals.

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Area of Science:

  • Hematology
  • Vascular Medicine
  • Oncology

Background:

  • Polycythemia vera (PV) is a myeloproliferative neoplasm associated with an increased risk of thrombosis.
  • Thromboembolic events are a major cause of morbidity and mortality in PV patients.
  • The D-dimer assay is a commonly used biomarker for excluding venous thromboembolism.

Observation:

  • A 65-year-old female patient with PV presented with right arm edema and was diagnosed with subclavian vein thrombosis via phlebography.
  • Despite a negative D-dimer assay, the patient subsequently developed a symptomatic pulmonary embolism.
  • This case highlights the limitations of D-dimer testing in specific clinical contexts.

Findings:

  • The D-dimer assay demonstrated a low negative predictive value in this PV patient with clinical signs of thromboembolism.

Related Experiment Videos

  • Phlebography confirmed acute subclavian vein thrombosis, and a subsequent pulmonary embolism occurred despite initial negative D-dimer results.
  • Diagnostic challenges arise when clinical suspicion for thromboembolism is high, irrespective of D-dimer assay results.

    • Implications:

    • Clinical assessment remains crucial for diagnosing thromboembolic events, even with negative D-dimer results in PV patients.
    • Prophylactic treatment with low-dose acetylsalicylic acid should be considered for PV patients due to the high frequency of thromboembolic events.
    • Further research into optimal thromboprophylaxis strategies for PV is warranted.