D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study
Gualtiero Palareti, Benilde Cosmi, Cristina Legnani, Emilia Antonucci, Valeria De Micheli, Angelo Ghirarduzzi, Daniela Poli, Sophie Testa, Alberto Tosetto, Vittorio Pengo, Paolo Prandoni, DULCIS (D-dimer and ULtrasonography in Combination Italian Study) Investigators, Gualtiero Palareti, Benilde Cosmi, Cristina Legnani, Nicoletta Erba, Valeria De Micheli, Angelo Ghirarduzzi, Maria Rosaria Veropalumbo, Ugolotti Maria Chiara, Daniela Poli, Domenico Prisco, Emilia Antonucci, Sophie Testa, Oriana Paoletti, Alberto Tosetto, Anna Falanga, Steidl Luigi, Marco Donadini, Elena Rancan, Roberto Quintavalla, Piera Maria Ferrini, Rita C Santoro, Francesco Orlandini, Raffaella Benedetti, Marco Cattaneo, Federico Lussana, Elena Bertinato, Roberto Cappelli, Attilia Maria Pizzini, Lucia Angeloni, Armando D'Angelo, Luciano Crippa, Roberta Bortolotti, Maria Rita Vandelli, Vittorio Pengo, Paolo Prandoni, Walter Ageno, Armando Tripodi, Davide Imberti, Marco Moia, Raffaele Pesavento, Nicola Magrini, Francesco Marongiu, Pietro Zonzin, Noemi Piaggesi, Mauro Silingardi, Gualtiero Palareti, Benilde Cosmi, Cristina Legnani, Emilia Antonucci, Valeria De Micheli, Angelo Ghirarduzzi, Daniela Poli, Sophie Testa, Alberto Tosetto, Vittorio Pengo, Paolo Prandoni, DULCIS (D-dimer and ULtrasonography in Combination Italian Study) Investigators, Gualtiero Palareti, Benilde Cosmi, Cristina Legnani, Nicoletta Erba, Valeria De Micheli, Angelo Ghirarduzzi, Maria Rosaria Veropalumbo, Ugolotti Maria Chiara, Daniela Poli, Domenico Prisco, Emilia Antonucci, Sophie Testa, Oriana Paoletti, Alberto Tosetto, Anna Falanga, Steidl Luigi, Marco Donadini, Elena Rancan, Roberto Quintavalla, Piera Maria Ferrini, Rita C Santoro, Francesco Orlandini, Raffaella Benedetti, Marco Cattaneo, Federico Lussana, Elena Bertinato, Roberto Cappelli, Attilia Maria Pizzini, Lucia Angeloni, Armando D'Angelo, Luciano Crippa, Roberta Bortolotti, Maria Rita Vandelli, Vittorio Pengo, Paolo Prandoni, Walter Ageno, Armando Tripodi, Davide Imberti, Marco Moia, Raffaele Pesavento, Nicola Magrini, Francesco Marongiu, Pietro Zonzin, Noemi Piaggesi, Mauro Silingardi
Abstract
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.
© 2014 by The American Society of Hematology.
Source: PubMed