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Comment on 'D-dimer and high-sensitivity C-reactive protein levels to predict venous thromboembolism recurrence after discontinuation of anticoagulation for cancer-associated thrombosis'

British Journal of Cancer volume 120, page 472 (2019)Cite this article

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With great interest, we read the paper by Jara-Palomares and colleagues, in which they show that D-dimer and high-sensitivity C-reactive protein predict recurrent venous thromboembolism (VTE) after discontinuation of anticoagulant treatment for cancer-associated VTE.1 Indeed, these results provide ground for discussion on a personalised approach to anticoagulation duration in this patient category, especially because of the well-known high risk of bleeding in anticoagulated patients with cancer.2

As an explanation for their findings, the authors propose that the biomarkers under study are markers of global coagulation activation, and thus of the potential for pathological clot formation.1 We propose an additional hypothesis—D-dimer and high-sensitivity C-reactive protein are not only markers of haemostatic activity in cancer patients, but also of active cancer itself.3,4 In this study, more than half of the patients had non-metastatic disease, and short life expectancy, cerebral metastases and a subjective assessment of the treating physician ('absence of circumstances favouring treatment maintenance based on the clinician’s discretion') were the exclusion criteria. Therefore, it seems that discontinuation of anticoagulation was not considered in patients with advanced cancer. Moreover, we wonder whether the cancer was in remission in a relevant number of the 114 included patients, and especially in those with low levels of the biomarkers.

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References

  1. Jara-Palomares, L. et al. D-dimer and high-sensitivity C-reactive protein levels to predict venous thromboembolism recurrence after discontinuation of anticoagulation for cancer-associated thrombosis. Br. J. Cancer 119, 915–921 (2018).

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  2. Prandoni, P. et al. Recurrent venous thromboembolism and bleeding complications during anticoagulant treatment in patients with cancer and venous thrombosis. Blood 100, 3484–3488 (2012).

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  4. Siemes, C. et al. C-reactive protein levels, variation in the C-reactive protein gene, and cancer risk: the Rotterdam Study. J. Clin. Oncol. 24, 5216–5222 (2006).

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  5. van der Hulle, T. et al. Cohort study on the management of cancer-associated venous thromboembolism aimed at the safety of stopping anticoagulant therapy in patients cured of cancer. Chest 149, 1245–1251 (2016).

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The manuscript was drafted by F.A.K. and approved of by all authors.

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  1. Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands

    Frederikus A. Klok, Henri H. Versteeg & Menno V. Huisman

  2. Department of Medical Oncology, Leiden University Medical Centre, Leiden, The Netherlands

    Arie J. Verschoor

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  1. Frederikus A. Klok
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  2. Henri H. Versteeg
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  3. Arie J. Verschoor
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  4. Menno V. Huisman
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Correspondence to Frederikus A. Klok.

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Klok, F.A., Versteeg, H.H., Verschoor, A.J. et al. Comment on 'D-dimer and high-sensitivity C-reactive protein levels to predict venous thromboembolism recurrence after discontinuation of anticoagulation for cancer-associated thrombosis'. Br J Cancer 120, 472 (2019). https://doi.org/10.1038/s41416-018-0361-x

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