D-dimer testing to select patients with a first unprovoked venous thromboembolism who can stop anticoagulant therapy: a cohort study
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Summary
This summary is machine-generated.For unprovoked venous thromboembolism (VTE), a negative D-dimer test after stopping anticoagulant therapy indicates a low recurrence risk in women, but not in men. Further research is needed for specific subgroups.
Area Of Science
- Cardiology
- Hematology
- Vascular Medicine
Background
- Normal D-dimer levels post-anticoagulant therapy correlate with reduced recurrence risk in unprovoked venous thromboembolism (VTE).
- This finding suggests that discontinuing anticoagulant treatment may be justifiable in select VTE patients.
Purpose Of The Study
- To evaluate the recurrence risk in patients experiencing their first unprovoked VTE.
- To determine if a negative D-dimer test result after stopping anticoagulant therapy is associated with a low risk of recurrence.
Main Methods
- A prospective management study involving 410 adults with a first unprovoked proximal deep vein thrombosis or pulmonary embolism.
- Participants completed 3-7 months of anticoagulant therapy, then stopped if D-dimer tests were negative.
- Recurrent VTE events were tracked over an average follow-up of 2.2 years.
Main Results
- Among 319 patients with two negative D-dimer results who stopped anticoagulation, the overall recurrent VTE rate was 6.7% per patient-year.
- Men had a higher recurrence rate (9.7% per patient-year) compared to women (5.4% per patient-year).
- Women with VTE associated with estrogen therapy had a 0.0% recurrence rate, while those without estrogen association had a 5.4% recurrence rate.
Conclusions
- The recurrence risk in men with unprovoked VTE and negative D-dimer results is not sufficiently low to warrant stopping anticoagulant therapy.
- For women with unprovoked VTE, a negative D-dimer test may indicate a low enough recurrence risk to justify discontinuing anticoagulant therapy.
- Imprecision in female subgroups and potential variability in D-dimer assay results necessitate cautious interpretation.