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

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 (unpr...

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Published inBlood Vol. 124; no. 2; pp. 196 - 203
Main Authors Palareti, Gualtiero, Cosmi, Benilde, Legnani, Cristina, Antonucci, Emilia, De Micheli, Valeria, Ghirarduzzi, Angelo, Poli, Daniela, Testa, Sophie, Tosetto, Alberto, Pengo, Vittorio, Prandoni, Paolo
Format Journal Article
LanguageEnglish
Published United States Elsevier Inc 10.07.2014
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ISSN0006-4971
1528-0020
1528-0020
DOI10.1182/blood-2014-01-548065

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Summary: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. •The duration of anticoagulation after VTE is uncertain; this management study intended to identify patients with low/high recurrence risk.•Patients with persistently negative D-dimers after stopping standard therapy have a low recurrence risk and can stop anticoagulation.
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ISSN:0006-4971
1528-0020
1528-0020
DOI:10.1182/blood-2014-01-548065