Details

Autor(en) / Beteiligte

• Kearon, Clive
• Spencer, Frederick A
• O'Keeffe, Denis
• Parpia, Sameer
• Schulman, Sam
• Baglin, Trevor
• Stevens, Scott M
• Kaatz, Scott
• Bauer, Kenneth A
• Douketis, James D
• Lentz, Steven R
• Kessler, Craig M
• Moll, Stephan
• Connors, Jean M
• Ginsberg, Jeffrey S
• Spadafora, Luciana
• Julian, Jim A

Titel

D-dimer testing to select patients with a first unprovoked venous thromboembolism who can stop anticoagulant therapy: a cohort study

Ist Teil von

• Annals of internal medicine, 2015-01, Vol.162 (1), p.27-34

Ort / Verlag

United States

Erscheinungsjahr

2015

Quelle

MEDLINE

Beschreibungen/Notizen

• Normal D-dimer levels after withdrawal of anticoagulant therapy are associated with a reduced risk for recurrence in patients with unprovoked venous thromboembolism (VTE) and may justify stopping treatment. To determine whether patients with a first unprovoked VTE and negative D-dimer test result who stop anticoagulant therapy have a low risk for recurrence. Prospective management study with blinded outcome assessment. (ClinicalTrials.gov: NCT00720915). 13 university-affiliated clinical centers. 410 adults aged 75 years or younger with a first unprovoked proximal deep venous thrombosis or pulmonary embolism who had completed 3 to 7 months of anticoagulant therapy. Anticoagulant therapy was stopped if D-dimer test results were negative and was not restarted if results were still negative after 1 month. Recurrent VTE during an average follow-up of 2.2 years. In 319 patients (78%) who had 2 negative D-dimer results and did not restart anticoagulant therapy, rates of recurrent VTE were 6.7% (95% CI, 4.8% to 9.0%) per patient-year overall (42 of 319), 9.7% (CI, 6.7% to 13.7%) per patient-year in men (33 of 180), 5.4% (CI, 2.5% to 10.2%) per patient-year in women with VTE not associated with estrogen therapy (9 of 81), and 0.0% (CI, 0.0% to 3.0%) per patient-year in women with VTE associated with estrogen therapy (0 of 58) (P = 0.001 for the 3-group comparison). Imprecision in female subgroups. Results may not be generalizable to different D-dimer assays from the one used in the study. The risk for recurrence in patients with a first unprovoked VTE who have negative D-dimer results is not low enough to justify stopping anticoagulant therapy in men but may be low enough to justify stopping therapy in women. Canadian Institutes of Health Research.