D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study.

Abstract

The optimal duration of anticoagulation in patients with venous thromboembolism (VTE) is uncertain. We investigated whether persistently negative D-dimers in patients with vein recanalization or stable thrombotic burden can identify subjects at low recurrence risk. Outpatients with a first VTE (unprovoked or associated with weak risk factors) were eligible after at least 3 months (12 in those with residual thrombosis) of anticoagulation. They received serial D-dimer measurements using commercial assays with predefined age/sex-specific cutoffs and were followed for up to 2 years. Of 1010 patients, anticoagulation was stopped in 528 (52.3%) with persistently negative D-dimer who subsequently experienced 25 recurrences (3.0% pt-y; 95% confidence interval [CI], 2.0-4.4%). Of the remaining 482 patients, 373 resumed anticoagulation and 109 refused it. Recurrent VTE developed in 15 patients (8.8% pt-y; 95% CI, 5.0-14.1) of the latter group and in 4 of the former (0.7% pt-y; 95% CI, 0.2-1.7; hazard ratio = 2.92; 95% CI, 1.87-9.72; P = .0006). Major bleeding occurred in 14 patients (2.3% pt-y; 95% CI, 1.3-3.9) who resumed anticoagulation. Serial D-dimer measurement is suitable in clinical practice for the identification of VTE patients in whom anticoagulation can be safely discontinued. This study was registered at clinicaltrials.gov as #NCT00954395.

• Authors: Gualtiero Palareti, Benilde Cosmi, Cristina Legnani, Emilia Antonucci, Valeria De Micheli, Angelo Ghirarduzzi, Daniela Poli, Sophie Testa, Alberto Tosetto, Vittorio Pengo, Paolo Prandoni, DULCIS (D-dimer and ULtrasonography in Combination Italian Study) Investigators
• Journal: Blood (Blood) Vol. 124 Issue 2 Pg. 196-203 (Jul 10 2014) ISSN: 1528-0020 [Electronic] United States
• PMID: 24879813 (Publication Type: Clinical Trial, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't)
• Copyright: © 2014 by The American Society of Hematology.

Chemical References

• Anticoagulants
• Fibrin Fibrinogen Degradation Products
• fibrin fragment D

Topics

• Aged
• Anticoagulants (administration & dosage)
• Drug Administration Schedule
• Female
• Fibrin Fibrinogen Degradation Products (analysis)
• Follow-Up Studies
• Humans
• Male
• Middle Aged
• Pregnancy
• Recurrence
• Time Factors
• Treatment Outcome
• Venous Thromboembolism (blood, diagnosis, drug therapy)
• Withholding Treatment