Details

Autor(en) / Beteiligte

• Palareti, Gualtiero
• Cosmi, Benilde
• Legnani, Cristina
• Antonucci, Emilia
• De Micheli, Valeria
• Ghirarduzzi, Angelo
• Poli, Daniela
• Testa, Sophie
• Tosetto, Alberto
• Pengo, Vittorio
• Prandoni, Paolo

Titel

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

Ist Teil von

• Blood, 2014-07, Vol.124 (2), p.196-203

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2014

Quelle

MEDLINE

Beschreibungen/Notizen

• 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.