Published online before print July 7, 2003, doi: 10.1161/01.CIR.0000079162.69615.0F
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
(Circulation. 2003;108:313.)
© 2003 American Heart Association, Inc.
Clinical Investigation and Reports |
Predictive Value of D-Dimer Test for Recurrent Venous Thromboembolism After Anticoagulation Withdrawal in Subjects With a Previous Idiopathic Event and in Carriers of Congenital Thrombophilia
From the Dipartimento di Angiologia, Unità Ricerca Clinica sulla Trombofilia "Marino Golinelli," University Hospital S Orsola-Malpighi, Bologna, and Dipartimento di Biochimica e Biologia Molecolare, University of Ferrara, Ferrara, Italy (B.L., F.B.).
Correspondence to Gualtiero Palareti, Department of Angiology, University Hospital S. Orsola-Malpighi, Via Massarenti 9, 40138 Bologna, Italy. E-mail palareti{at}tin.it
Background— We have shown that normal D-dimer levels obtained after the discontinuation of oral anticoagulant treatment (OAT) has a high negative predictive value for recurrent venous thromboembolism (VTE). The aim of the present study was to assess the predictive value of D-dimer for recurrent VTE in subjects with a previous unprovoked event who are either carriers of inherited thrombophilia or not.
Methods and Results— We prospectively evaluated 599 patients (301 males) with a previous VTE episode. They were repeatedly examined for D-dimer levels after OAT withdrawal and were screened for inherited thrombophilic alterations. Alterations were detected in 130 patients (21.7%), factor V Leiden (70 patients; 2 of whom were homozygotes) and prothrombin mutation (38 patients) were the most prevalent ones. Recurrent events were recorded in 58 subjects (9.7%) during a follow-up of 870.7 patient-years. Altered D-dimer levels at 1 month after OAT withdrawal were associated with a higher rate of subsequent recurrence in all subjects investigated, especially in those with an unprovoked qualifying VTE event (hazard ratio, 2.43; 95% confidence interval, 1.18 to 4.61) and in those with thrombophilia (hazard ratio, 8.34; 95% confidence interval, 2.72 to 17.43). The higher relative risk for recurrence of altered D-dimer was confirmed by multivariate analysis after adjustment for other risk factors. The negative predictive value of D-dimer was 92.9% and 95.8% in subjects with an unprovoked qualifying event or with thrombophilia, respectively.
Conclusions— D-dimer levels measured 1 month after OAT withdrawal have a high negative predictive value for recurrence in subjects with unprovoked VTE who are either carriers or not carriers of congenital thrombophilia.
Key Words: thrombophilia • fibrin fibrinogen degradation product • thromboembolism • thrombosis
This article has been cited by other articles:
 |
|
 |
|
  C. Ay, R. Vormittag, D. Dunkler, R. Simanek, A.-L. Chiriac, J. Drach, P. Quehenberger, O. Wagner, C. Zielinski, and I. Pabinger D-Dimer and Prothrombin Fragment 1 + 2 Predict Venous Thromboembolism in Patients With Cancer: Results From the Vienna Cancer and Thrombosis Study J. Clin. Oncol., September 1, 2009; 27(25): 4124 - 4129. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. B. Segal, D. J. Brotman, A. J. Necochea, A. Emadi, L. Samal, L. M. Wilson, M. T. Crim, and E. B. Bass Predictive Value of Factor V Leiden and Prothrombin G20210A in Adults With Venous Thromboembolism and in Family Members of Those With a Mutation: A Systematic Review JAMA, June 17, 2009; 301(23): 2472 - 2485. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Preventing recurrent venous thromboembolism DTB, April 1, 2009; 47(4): 38 - 40. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. Pabinger and C. Ay Biomarkers and Venous Thromboembolism Arterioscler Thromb Vasc Biol, March 1, 2009; 29(3): 332 - 336. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. M. Schellong, H. Bounameaux, and H. R. Büller CHAPTER 37 Venous Thromboembolism ESC Textbook of Cardiovascular Medicine, January 1, 2009; 2(1): med-9780199566990-chapter - med-9780199566990-chapter. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Verhovsek, J. D. Douketis, Q. Yi, S. Shrivastava, R. C. Tait, T. Baglin, D. Poli, and W. Lim Systematic Review: D-Dimer to Predict Recurrent Disease after Stopping Anticoagulant Therapy for Unprovoked Venous Thromboembolism Ann Intern Med, October 7, 2008; 149(7): 481 - 490. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Legnani, G. Palareti, B. Cosmi, M. Cini, A. Tosetto, A. Tripodi, and for the PROLONG Investigators (on behalf of FCSA a Different cut-off values of quantitative D-dimer methods to predict the risk of venous thromboembolism recurrence: a post-hoc analysis of the PROLONG study Haematologica, June 1, 2008; 93(6): 900 - 907. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C. Kearon, S. R. Kahn, G. Agnelli, S. Goldhaber, G. E. Raskob, and A. J. Comerota Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition) Chest, June 1, 2008; 133(6_suppl): 454S - 545S. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. V. Cuderman, M. Bozic, P. Peternel, and M. Stegnar Hemostasis Activation in Thrombophilic Subjects With or Without a History of Venous Thrombosis Clinical and Applied Thrombosis/Hemostasis, January 1, 2008; 14(1): 55 - 62. [Abstract] [PDF]
|
|
|
|
 |
|
 S. Habara, K. Dote, M. Kato, S. Sasaki, K. Goto, H. Takemoto, D. Hasegawa, and O. Matsuda Prediction of left atrial appendage thrombi in non-valvular atrial fibrillation Eur. Heart J., September 2, 2007; 28(18): 2217 - 2222. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Marchiori, L. Mosena, M. H. Prins, and P. Prandoni The risk of recurrent venous thromboembolism among heterozygous carriers of factor V Leiden or prothrombin G20210A mutation. A systematic review of prospective studies Haematologica, August 1, 2007; 92(8): 1107 - 1114. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Prandoni, F. Noventa, A. Ghirarduzzi, V. Pengo, E. Bernardi, R. Pesavento, M. Iotti, D. Tormene, P. Simioni, and A. Pagnan The risk of recurrent venous thromboembolism after discontinuing anticoagulation in patients with acute proximal deep vein thrombosis or pulmonary embolism. A prospective cohort study in 1,626 patients Haematologica, February 1, 2007; 92(2): 199 - 205. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Palareti, B. Cosmi, C. Legnani, A. Tosetto, C. Brusi, A. Iorio, V. Pengo, A. Ghirarduzzi, C. Pattacini, S. Testa, et al. D-Dimer Testing to Determine the Duration of Anticoagulation Therapy N. Engl. J. Med., October 26, 2006; 355(17): 1780 - 1789. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. von Kanel, J. E. Dimsdale, P. J. Mills, S. Ancoli-Israel, T. L. Patterson, B. T. Mausbach, and I. Grant Effect of Alzheimer caregiving stress and age on frailty markers interleukin-6, C-reactive protein, and d-dimer. J. Gerontol. A Biol. Sci. Med. Sci., September 1, 2006; 61(9): 963 - 969. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. K. Ho, G. J. Hankey, D. J. Quinlan, and J. W. Eikelboom Risk of recurrent venous thromboembolism in patients with common thrombophilia: a systematic review. Arch Intern Med, April 10, 2006; 166(7): 729 - 736. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. W. Ely, J. A. Osheroff, M. L. Chambliss, and M. H. Ebell Approach to Leg Edema of Unclear Etiology J Am Board Fam Med, March 1, 2006; 19(2): 148 - 160. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. K. Moores Diagnosis and Management of Pulmonary Embolism: Are We Moving Toward an Outcome Standard? Arch Intern Med, January 23, 2006; 166(2): 147 - 148. [Full Text] [PDF]
|
|
|
|
 |
|
 P. L. Bockenstedt Management of Hereditary Hypercoagulable Disorders Hematology, January 1, 2006; 2006(1): 444 - 449. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Z. Goldhaber Prevention of Recurrent Idiopathic Venous Thromboembolism Circulation, December 14, 2004; 110(24_suppl_1): IV-20 - IV-24. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Kearon Long-Term Management of Patients After Venous Thromboembolism Circulation, August 31, 2004; 110(9_suppl_1): I-10 - I-18. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. Prandoni Ximelagatran reduced venous thromboembolism more than warfarin after total knee replacement Evid. Based Med., July 1, 2004; 9(4): 106 - 106. [Full Text] [PDF]
|
|
|
|
|
|
P. Prandoni Ximelagatran prevented secondary venous thromboembolism Evid. Based Med., July 1, 2004; 9(4): 107 - 107. [Full Text] [PDF]
|
|
|
|
 |
|
 B. M. Errichi, M. R. Cesarone, G. Belcaro, R. Marinucci, A. Ricci, A. Ippolito, R. Brandolini, G. Vinciguerra, M. Dugall, A. Felicita, et al. Prevention of Recurrent Deep Venous Thrombosis with Sulodexide: The SanVal Registry Angiology, May 1, 2004; 55(3): 243 - 249. [Abstract] [PDF]
|
|
|
|
|
|
J. I. Weitz, S. Middeldorp, W. Geerts, and J. A. Heit Thrombophilia and New Anticoagulant Drugs Hematology, January 1, 2004; 2004(1): 424 - 438. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Lopez, C. Kearon, and A. Y.Y. Lee Deep Venous Thrombosis Hematology, January 1, 2004; 2004(1): 439 - 456. [Abstract] [Full Text] [PDF]
|
|