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 5 2.92; 95% CI, 1.87-9.72; P 5 .0006). Major bleeding occurred in 14 patients (2.3% pt-y;95%CI, 1.3-3.9)whoresumedanticoagulation. 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

Palareti, G., Cosmi, B., Legnani, C., Antonucci, E., De Micheli, V., Ghirarduzzi, A., et al. (2014). D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study. BLOOD, 124(2), 196-203 [10.1182/blood-2014-01-548065].

D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study

Falanga A
Membro del Collaboration Group
;
2014

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 5 2.92; 95% CI, 1.87-9.72; P 5 .0006). Major bleeding occurred in 14 patients (2.3% pt-y;95%CI, 1.3-3.9)whoresumedanticoagulation. 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
Articolo in rivista - Articolo scientifico
anticoagulation, fibrin fragment d substance, venous thromboembolism, recurrence risk
Italian
2014
124
2
196
203
none
Palareti, G., Cosmi, B., Legnani, C., Antonucci, E., De Micheli, V., Ghirarduzzi, A., et al. (2014). D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study. BLOOD, 124(2), 196-203 [10.1182/blood-2014-01-548065].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/262092
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