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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
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.