D-dimer levels and recurrence in patients with unprovoked VTE and a negative qualitative D-dimer test after treatment. Issue 146 (October 2016)

• Record Type: Journal Article
• Authors: Kearon, C.; Parpia, S.; Spencer, F.A.; Baglin, T.; Stevens, S.M.; Bauer, K.A.; Lentz, S.R.; Kessler, C.M.; Douketis, J.D.; Moll, S.; Kaatz, S.; Schulman, S.; Connors, J.M.; Ginsberg, J.S.; Spadafora, L.; Liaw, P.C.; Weitz, J.I.; Julian, J.A.
• Is Part Of: Thrombosis research. Issue 146(2016)
• Page Start: 119
• Page End: 125
• Publication Date: 2016-10
• Subjects: Cohort study -- D-dimer -- Forecasting -- Prognosis -- Venous thrombosis; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2016.06.023
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Background: The rate of recurrent venous thromboembolism (VTE) in patients with a first unprovoked VTE who had a negative qualitative D-dimer test one month after stopping anticoagulant therapy was higher than expected in the D-dimer Optimal Duration Study (DODS). Objectives: To determine whether quantitative D-dimer levels using a low threshold, age- and sex-specific thresholds, or repeated measurements, would improve identification of patients at low risk of recurrent VTE. Materials and methods: D-dimer levels were quantified in banked samples from 307 patients in DODS who had a negative qualitative D-dimer test while on, and 1 month after stopping, anticoagulant therapy and the rates of recurrent VTE were determined in patients with D-dimer levels below various predefined thresholds. Results: The rate (per patient year) of recurrent VTE was: 5.9% with D-dimer levels < 250 μg/l at one month; 5.2% with D-dimer levels between 250 and 499 μg/l at one month; 5.0% with D-dimer levels less than predefined age- and sex-specific thresholds at one month; and 6.3% when D-dimer levels were < 500 μg/l at both one and 7 months after stopping anticoagulant therapy. These rates are similar to the overall event rate of 6.3% in patients who stopped treatment. Conclusions: Among unprovoked VTE patients who had a negative qualitative D-dimer test during and after anticoagulant therapy, low D-dimer thresholds, age and sex-adjusted thresholds or repeated measurements, did not identify subgroups with a very low rate of recurrence. Highlights: Recurrences were high after unprovoked VTE with a negative qualitative D-dimer test. Low quantitative D-dimer levels might better identify low risk patients. We assessed very low, sex- and age-specific, and repeated D-dimer levels. None of these testing strategies were able to identify a very low recurrence risk.