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Recurrent venous thromboembolism: association with thrombin generation and d-dimer.
Eugenia Biguzzi1,2,3, Kristien Winckers4, Tilman M Hackeng4
1Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
Research and Practice in Thrombosis and Haemostasis
|April 13, 2026
Summary
D-dimer and thrombin generation levels help identify patients at high risk for recurrent venous thromboembolism (VTE). Combining these markers aids clinicians in deciding on long-term anticoagulation therapy for VTE prevention.
Area of Science:
- Hematology
- Thrombosis Research
- Clinical Medicine
Background:
- Venous thromboembolism (VTE) poses a significant risk of recurrent thrombosis.
- Clinicians face challenges in determining optimal anticoagulation duration after a first VTE event.
- Risk stratification is crucial for managing recurrent VTE.
Purpose of the Study:
- To investigate the association between recurrent VTE and biomarkers d-dimer and thrombin generation.
- To stratify VTE recurrence risk based on combined d-dimer and thrombin generation levels.
- To inform clinical decisions regarding anticoagulation therapy.
Main Methods:
- Analysis of 1895 individuals from the MEGA case-control study.
- Prospective follow-up for recurrent VTE events.
- Cox proportional hazard regression models to estimate incidence rates and hazard ratios for VTE risk stratification based on d-dimer and thrombin generation levels.
Main Results:
- Three distinct risk classes for recurrent VTE were identified: low, intermediate, and high.
- Patients with high d-dimer and high thrombin generation exhibited the highest incidence rate of recurrent VTE (4.70/100 patient-years).
- In unprovoked VTE subgroup, high d-dimer and thrombin generation indicated a significantly elevated risk (9.80/100 patient-years).
Conclusions:
- The combined assessment of d-dimer and thrombin generation effectively stratifies VTE recurrence risk.
- This combined approach aids in identifying high-risk patients who may benefit from extended anticoagulation.
- Optimizing anticoagulation duration can improve outcomes for patients with a history of VTE.
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