Blood. 2014 May 30.
D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study.
Palareti G1, et al.
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 cut-offs and were followed up for up to two years. Out 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% 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; HR = 2.92; 95% CI 1.87 - 9.72; P = 0.0006). Major bleedings 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.
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