D-Dimer Level and the Risk for Thrombosis in Systemic Lupus Erythematosus

• Published in: Clinical journal of the American Society of Nephrology Vol. 3; no. 6; pp. 1628 - 1636
• Main Authors: Wu, Haifeng, Birmingham, Daniel J., Rovin, Brad, Hackshaw, Kevin V., Haddad, Nabil, Haden, Douglas, Yu, Chack-Yung, Hebert, Lee A.
• Format: Journal Article
• Language: English
• Published: United States American Society of Nephrology 01.11.2008
• Subjects: Adult; Antibodies, Antiphospholipid - blood; Biomarkers - blood; Clinical Nephrology; Female; Fibrin Fibrinogen Degradation Products - metabolism; Humans; Longitudinal Studies; Lupus Erythematosus, Systemic - blood; Lupus Erythematosus, Systemic - complications; Lupus Erythematosus, Systemic - immunology; Male; Middle Aged; Predictive Value of Tests; Prospective Studies; Recurrence; Risk Assessment; Risk Factors; Thrombosis - blood; Thrombosis - etiology; Time Factors; Up-Regulation; Young Adult
• ISSN: 1555-9041; 1555-905X; 1555-905X
• DOI: 10.2215/CJN.01480308

Patients who have systemic lupus erythematosus (SLE) and manifest antiphospholipid antibodies (APA) are at increased risk for thrombosis; however, it is difficult to predict who will clot. This study tested the hypothesis that peak D-dimer level measured routinely during follow-up identifies whether a hypercoagulable state is developing and, therefore, the patient is at increased risk for thrombosis. One hundred consecutive patients who had SLE with recurrent activity (71% renal SLE) and were evaluated for or enrolled in the Ohio SLE Study were studied. D-dimer testing was done annually and usually at SLE flare or other serious illness. When D-dimer was elevated, evaluation for thrombosis (large vessel, small vessel, or Libman-Sacks) was undertaken. Mean follow-up was 37.5 +/- 15 SD months. Of those with peak D-dimer <0.5 microg/ml (n = 46), 0% thrombosed, 33% had APA. Of those with peak D-dimer 0.5 to 2.0 microg/ml (n = 19), 6% thrombosed, 44% had APA. Of those with peak D-dimer >2.0 microg/ml (n = 36), 42% thrombosed, 76% had APA. The most common causes of elevated D-dimer in the absence of demonstrable thrombosis were SLE flare and systemic infection. D-dimer levels were usually elevated for several months before thrombosis. Patients with SLE and normal D-dimer levels are at low risk for thrombosis, irrespective of APA status. Those with persistent unexplained elevated D-dimer levels, particularly when >2.0 microg/ml, are at high risk for thrombosis.