D-ダイマー濃度と再発性静脈血栓塞栓症のリスク
Sabine Eichinger1, Erich Minar, Christine Bialonczyk
1Department of Internal Medicine I, University of Vienna, Austria. sabine.eichinger@akh-wien.ac.at
JAMA
|August 28, 2003
まとめ
静脈血栓塞栓症 (VTE) が初めて発生した患者で,抗凝固薬の投与を中止した後にD-ダイマー濃度が低い患者は,静脈血栓塞栓症の再発のリスクが低下しています. この発見は,将来の血栓に対する個々の患者のリスクを評価するのに役立ちます.
科学分野:
- 血液学 ヘマトロジ
- クリニカル・メディシン 臨床医学
- トロンボシス研究研究
背景:
- 血栓性リスク因子のスクリーニングは,静脈血栓塞栓症 (VTE) 患者にとって一般的です.
- 個々のVTE再発リスクの評価は,多数のリスク要因のために複雑です.
- 多因子性血栓性疾患の評価のための実験方法が必要である.
研究 の 目的:
- D-ダイマー濃度と再発性VTEのリスクとの関連性を将来的に調査する.
- VTE再発の予測における凝固活性化と線維分解のグローバルマーカーとしてD-ジメルを評価する.
主な方法:
- 口服抗凝固剤で治療された最初の自発的なVTEを持つ610人の患者の前向きなコホート研究.
- D-ダイマー濃度は,経口抗凝固薬の中止後に測定されました.
- 患者は平均38ヶ月間,再発性VTEをモニターした.
主要な成果:
- 再発性VTEは,患者の13%で発生しました.
- D-ダイマー濃度の上昇は,再発性VTE (553ng/mL対427ng/mL,P=0.01) と有意に関連していた.
- D-ダイマー<250ng/mLの患者は,2年後の累積的な再発確率 (3.7%対11.5%,P=.001) が著しく低下し,再発の相対リスクが60%低下しました.
結論:
- 経口抗凝固剤を中止した後に250ng/mL未満のD-ダイマーレベルは,VTE再発のリスクが低いことを示します.
- D-ダイマー測定は,VTEの病歴のある患者のリスク分層化のための貴重なツールです.
- この発見は,VTE再発の個別化されたリスク評価を支持しています.
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