D-dimer levels and risk of recurrence following provoked venous thromboembolism: findings from the RIETE registry.
Por:
Avnery O, Martin M, Bura-Riviere A, Barillari G, Mazzolai L, Mahé I, Marchena P, Verhamme P, Monreal M, Ellis MH and RIETE Investigators
Publicada:
1 ene 2020
Ahead of Print:
27 ago 2019
Categoría:
Internal medicine
Resumen:
BACKGROUND: Patients with venous thromboembolism (VTE) secondary to transient risk factors may develop VTE recurrences after discontinuing anticoagulation. Identifying at-risk patients could help to guide the duration of therapy. METHODS: We used the RIETE database to assess the prognostic value of d-dimer testing after discontinuing anticoagulation to identify patients at increased risk for recurrences. Transient risk factors were classified as major (postoperative) or minor (pregnancy, oestrogen use, immobilization or recent travel). RESULTS: In December 2018, 1655 VTE patients with transient risk factors (major 460, minor 1195) underwent d-dimer measurements after discontinuing anticoagulation. Amongst patients with major risk factors, the recurrence rate was 5.74 (95% CI: 3.19-9.57) events per 100 patient-years in those with raised d-dimer levels and 2.68 (95% CI: 1.45-4.56) in those with normal levels. Amongst patients with minor risk factors, the rates were 7.79 (95% CI: 5.71-10.4) and 3.34 (95% CI: 2.39-4.53), respectively. Patients with major risk factors and raised d-dimer levels (n = 171) had a nonsignificantly higher rate of recurrences (hazard ratio [HR]: 2.14; 95% CI: 0.96-4.79) than those with normal levels. Patients with minor risk factors and raised d-dimer levels (n = 382) had a higher rate of recurrences (HR: 2.34; 95% CI: 1.51-3.63) than those with normal levels. On multivariate analysis, raised d-dimers (HR: 1.74; 95% CI: 1.09-2.77) were associated with an increased risk for recurrences in patients with minor risk factors, not in those with major risk factors. CONCLUSIONS: Patients with raised d-dimer levels after discontinuing anticoagulant therapy for VTE provoked by a minor transient risk factor were at an increased risk for recurrences.
Filiaciones:
Avnery O:
Meir Medical Center, Hematology Institute and Blood Bank, Kfar Saba, Israel
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Martin M:
Hospital Infanta Sofia San Sebastian de los Reyes and Universidad Europea de Madrid, Madrid, Spain
Bura-Riviere A:
Department of Vascular Medicine, Hôpital de Rangueil, Toulouse, France
Barillari G:
Department of Internal Medicine, Ospedale S. Maria della Misericordia, Udine, Italy
Mazzolai L:
Department of Angiology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
Mahé I:
Department of Internal Medicine, Hôpital Louis Mourier, Colombes (APHP), University Paris 7, Colombes, France
Marchena P:
Department of Internal Medicine and Emergency, Parc Sanitari Sant Joan de Deu-Hospital General, Barcelona, Spain
Verhamme P:
Vascular Medicine and Haemostasis, University of Leuven, Leuven, Belgium
Monreal M:
Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
Ellis MH:
Meir Medical Center, Hematology Institute and Blood Bank, Kfar Saba, Israel
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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