D-dimer at venous thrombosis diagnosis is associated with risk of recurrence
| Autor: | Esben Bjøri, Sigrid Kufaas Brækkan, John-Bjarne Hansen, Håkon Sandbukt Johnsen |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Deep vein 030204 cardiovascular system & hematology Risk Assessment Fibrin Fibrinogen Degradation Products 03 medical and health sciences 0302 clinical medicine Predictive Value of Tests Recurrence Risk Factors Internal medicine Epidemiology D-dimer Medicine Humans cardiovascular diseases 030212 general & internal medicine Aged Aged 80 and over Venous Thrombosis business.industry Norway Incidence Absolute risk reduction Hematology Venous Thromboembolism Middle Aged medicine.disease Prognosis Thrombosis Confidence interval Venous thrombosis medicine.anatomical_structure Quartile Female business Biomarkers |
| Zdroj: | Journal of thrombosis and haemostasis : JTH. 15(5) |
| ISSN: | 1538-7836 |
| Popis: | Essentials Whether D-dimer at incident venous thromboembolism (VTE) can predict recurrence-risk is unknown. We explored this association in 454 cancer-free patients with a first lifetime VTE. A low D-dimer at first VTE diagnosis was associated with a low recurrence risk. The association was predominant in patients with deep vein thrombosis and unprovoked VTE. Click to hear Dr Cannegieter's presentation on venous thrombosis: prediction of recurrence SUMMARY: Background Venous thromboembolism (VTE) is a common disease with a high recurrence rate. D-dimer measured after cessation of anticoagulant therapy predicts recurrence, and is used to decide on treatment prolongation. However, whether D-dimer measured at first VTE diagnosis can be used to assess recurrence-risk is unknown. Aims To investigate the association between D-dimer, measured at first VTE diagnosis and risk of recurrent VTE. Methods Information on clinical risk factors and laboratory markers were collected in 454 cancer-free patients with a first VTE. Recurrent VTEs and deaths during follow-up (1994-2012) were recorded. Results During a median follow-up of 3.9 years, 84 patients experienced a recurrent VTE. The crude recurrence rate was 1.7 (95% confidence interval [CI], 1.0-2.9) per 100 person-years in the lower quartile of D-dimer (≤ 1500 ng mL-1 ), and 4.9 (95% CI, 3.9-6.1) per 100 person-years in the upper three quartiles combined, yielding an absolute risk difference of 3.2 per 100 person-years. Patients with D-dimer ≤ 1500 ng mL-1 had 54% lower recurrence-risk than patients with D-dimer > 1500 ng mL-1 (HR, 0.46; 95% CI, 0.25-0.82). The association was particularly pronounced among patients with unprovoked events and deep vein thrombosis, showing a 66% (HR, 0.34; 95% CI, 0.15-0.74) and 68% (HR, 0.32; 95% CI, 0.14-0.71) lower recurrence risk among patients with D-dimer ≤ 1500 ng mL-1 , respectively. Conclusions A low D-dimer (≤ 1500 ng mL-1 ) measured at first VTE diagnosis was associated with a low recurrence risk, particularly among patients with DVT and unprovoked events. Our findings suggest that a clinical decision to avoid prolonged anticoagulant treatment could be considered based on low D-dimer at the time of VTE diagnosis. |
| Databáze: | OpenAIRE |
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