Published Online
on July 7, 2003

A more recent version of this article appeared on July 22, 2003

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Submitted on January 16, 2003
Revised on April 18, 2003
Accepted on April 21, 2003

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

Gualtiero Palareti MD^*, Cristina Legnani MS, Benilde Cosmi MD, Lelia Valdré MD, Barbara Lunghi MS, Francesco Bernardi MS, and Sergio Coccheri MD

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.).

^* To whom correspondence should be addressed. 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

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