A Retrospective Analysis of Plasma D-dimer Dynamic Variation in Terminal Stage Cancer Patients: Implications for Disease Progression

Elevated D-dimer is frequently found among cancer patients especially for advanced stage patients. Activation of the coagulation system and the fibrinolytic cascade are supposed to be associated with higher risk of invasion, metastases and worse outcome. The purpose of this study is to investigate the dynamic variation of plasma D-dimer and its relationship with other markers of the coagulation system including platelet counts, fibrinogen levels, prothrombin time (PT), activated partial thromboplastin time (APTT) and thrombin time (TT) in terminal stage cancer patients. We designed a self-controlled study to compare plasma D-dimer dynamic variation from 0-4 weeks to 4-8 weeks before patients' death. The plasma D-dimer levels pointed an elevated tendency and revealed statistically significant difference as patients gradually near death. Prolonged PT, APTT and TT were found. D-dimer levels were positively correlated with PT, APTT and TT but showed negative correlation with platelet counts and fibrinogen levels. Plasma D-dimer levels gradually increased as terminal stage cancer patients approaching to death. Increasing D-dimer levels may predict worse outcome.