Abstract | BACKGROUND: OBJECTIVES: To evaluate D-dimer and FVIIIc as risk factors for recurrent VTE and assess the efficacy of extended low-intensity warfarin (target International Normalized Ratio 1.5-2.0) in preventing recurrence by biomarker level. PATIENTS AND METHODS: In the Prevention of Recurrent Venous Thromboembolism trial, 508 idiopathic VTE patients treated for > or = 3 months with full-intensity warfarin, and who had stopped warfarin for 7 weeks on average, were randomized to low-intensity warfarin or placebo and followed for 2.1 years for recurrent VTE. Prerandomization blood samples were analysed for D-dimer and FVIIIc. RESULTS: One-third of participants had elevated baseline D-dimer (> or = 500 ng mL(-1)) and one-fourth, elevated FVIIIc (> or = 150 IU dL(-1)). Adjusting for other risk factors, the hazard ratios (HRs) for recurrent VTE with elevated D-dimer or FVIIIc were 2.0 [95% confidence interval (CI) 1.2-3.4] and 1.5 (95% CI 0.8-2.8), respectively. The association of elevated D-dimer with recurrence was larger among patients with one prior VTE (HR 3.2, 95% CI 1.3-8.0) than in patients with more than one event (HR 1.4, 95% CI 0.7-2.2). For patients with one prior VTE on placebo, the annual recurrence incidence was 10.9% with elevated D-dimer and 2.9% with normal values. Low-intensity warfarin was equally effective in recurrence risk reduction in those with normal or elevated biomarkers. CONCLUSIONS: Among patients with idiopathic VTE, measurement of D-dimer, but not FVIIIc, might be useful for risk stratification. The efficacy of extended low-intensity warfarin therapy did not vary by biomarker level.
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Authors | S Shrivastava, P M Ridker, R J Glynn, S Z Goldhaber, S Moll, H Bounameaux, K A Bauer, C M Kessler, M Cushman |
Journal | Journal of thrombosis and haemostasis : JTH
(J Thromb Haemost)
Vol. 4
Issue 6
Pg. 1208-14
(Jun 2006)
ISSN: 1538-7933 [Print] England |
PMID | 16706961
(Publication Type: Journal Article, Randomized Controlled Trial, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
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Chemical References |
- Anticoagulants
- Biomarkers
- Fibrin Fibrinogen Degradation Products
- fibrin fragment D
- Warfarin
- F8 protein, human
- Factor VIII
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Topics |
- Adult
- Aged
- Anticoagulants
(administration & dosage, therapeutic use)
- Biomarkers
(blood)
- Double-Blind Method
- Drug Administration Schedule
- Factor VIII
(metabolism)
- Female
- Fibrin Fibrinogen Degradation Products
(metabolism)
- Humans
- Male
- Middle Aged
- Risk Factors
- Secondary Prevention
- Thromboembolism
(blood, drug therapy, prevention & control)
- Venous Thrombosis
(blood, drug therapy, prevention & control)
- Warfarin
(administration & dosage, therapeutic use)
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