D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study
| Autor: | Palareti G, Cosmi B, Legnani C, Antonucci E, De Micheli V, Ghirarduzzi A, Poli D, Testa S, Tosetto A, Pengo V, Prandoni P, Erba N, Veropalumbo MR, Chiara UM, Prisco D, Paoletti O, Falanga A, Luigi S, Donadini M, Rancan E, Quintavalla R, Ferrini PM, Santoro RC, Orlandini F, Benedetti R, Cattaneo M, Lussana F, Bertinato E, Cappelli R, Pizzini AM, Angeloni L, D'Angelo A, Crippa L, Bortolotti R, Vandelli MR, Ageno W, Tripodi A, Imberti D, Moia M, Pesavento R, Magrini N, Marongiu F, Zonzin P, Piaggesi N, Silingardi M |
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| Přispěvatelé: | Palareti, G, Cosmi, B, Legnani, C, Antonucci, E, De Micheli, V, Ghirarduzzi, A, Poli, D, Testa, S, Tosetto, A, Pengo, V, Prandoni, P, Erba, N, Veropalumbo, M, Chiara, U, Prisco, D, Paoletti, O, Falanga, A, Luigi, S, Donadini, M, Rancan, E, Quintavalla, R, Ferrini, P, Santoro, R, Orlandini, F, Benedetti, R, Cattaneo, M, Lussana, F, Bertinato, E, Cappelli, R, Pizzini, A, Angeloni, L, D'Angelo, A, Crippa, L, Bortolotti, R, Vandelli, M, Ageno, W, Tripodi, A, Imberti, D, Moia, M, Pesavento, R, Magrini, N, Marongiu, F, Zonzin, P, Piaggesi, N, Silingardi, M, Gualtiero Palareti, Benilde Cosmi, Cristina Legnani, Emilia Antonucci, Valeria De Micheli, Angelo Ghirarduzzi, Daniela Poli, Sophie Testa, Alberto Tosetto, Vittorio Pengo, and Paolo Prandoni, on behalf of the DULCIS (D-dimer and ULtrasonography in Combination Italian Study) Investigators |
| Jazyk: | angličtina |
| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Immunology Biochemistry Drug Administration Schedule Fibrin Fibrinogen Degradation Products Pregnancy Recurrence Internal medicine D-dimer medicine Humans D-dimer venous thromboembolism vitamin K antagonists Vein Aged Hematology business.industry Hazard ratio Anticoagulants Cell Biology Venous Thromboembolism Middle Aged medicine.disease Thrombosis Confidence interval Surgery Clinical trial medicine.anatomical_structure Treatment Outcome Withholding Treatment Female business anticoagulation fibrin fragment d substance venous thromboembolism recurrence risk Follow-Up Studies |
| Popis: | 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 = 2.92; 95% CI, 1.87-9.72; P = .0006). Major bleeding 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. This study was registered at clinicaltrials.gov as #NCT00954395. |
| Databáze: | OpenAIRE |
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