Predictive Value of D-Dimer Test for Recurrent Venous Thromboembolism After Anticoagulation Withdrawal in Subjects With a Previous Idiopathic Event and in Carriers of Congenital Thrombophilia

• DOI: 10.1161/01.cir.0000079162.69615.0f
• Publication Date: 2003-07-08T00:33:57Z
• Authors: Gualtiero Palareti; Cristina Legnani; Benilde Cosmi; Lelia Valdré; Barbara Lunghi; Francesco Bernardi; Sergio Coccheri
• Keywords: Adult; Male; Heterozygote; Adolescent; Administration, Oral; Fibrin fibrinogen degradation product; Thromboembolism; Thrombophilia; Thrombosis; Administration, Oral; Adolescent; Adult; Aged; Aged, 80 and over; Anticoagulants; Child; Cohort Studies; Female; Fibrin Fibrinogen Degradation Products; Heterozygote; Humans; Male; Mass Screening; Middle Aged; Predictive Value of Tests; Prospective Studies; Risk Assessment; Secondary Prevention; Sensitivity and Specificity; Thromboembolism; Thrombophilia; Time Factors; Venous Thrombosis; Risk Assessment; Sensitivity and Specificity; Cohort Studies; Fibrin Fibrinogen Degradation Products; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; Secondary Prevention; Humans; Mass Screening; Prospective Studies; Child; Fibrin fibrinogen degradation product; Thromboembolism; Thrombophilia; Thrombosis;; Aged; Aged, 80 and over; Anticoagulants; Middle Aged; 3. Good health; Female

Background—

We have shown that normal D-dimer levels obtained after the discontinuation of oral anticoagulant treatment (OAT) has a high negative predictive value for recurrent venous thromboembolism (VTE). The aim of the present study was to assess the predictive value of D-dimer for recurrent VTE in subjects with a previous unprovoked event who are either carriers of inherited thrombophilia or not.

Methods and Results—

We prospectively evaluated 599 patients (301 males) with a previous VTE episode. They were repeatedly examined for D-dimer levels after OAT withdrawal and were screened for inherited thrombophilic alterations. Alterations were detected in 130 patients (21.7%), factor V Leiden (70 patients; 2 of whom were homozygotes) and prothrombin mutation (38 patients) were the most prevalent ones. Recurrent events were recorded in 58 subjects (9.7%) during a follow-up of 870.7 patient-years. Altered D-dimer levels at 1 month after OAT withdrawal were associated with a higher rate of subsequent recurrence in all subjects investigated, especially in those with an unprovoked qualifying VTE event (hazard ratio, 2.43; 95% confidence interval, 1.18 to 4.61) and in those with thrombophilia (hazard ratio, 8.34; 95% confidence interval, 2.72 to 17.43). The higher relative risk for recurrence of altered D-dimer was confirmed by multivariate analysis after adjustment for other risk factors. The negative predictive value of D-dimer was 92.9% and 95.8% in subjects with an unprovoked qualifying event or with thrombophilia, respectively.

Conclusions—

D-dimer levels measured 1 month after OAT withdrawal have a high negative predictive value for recurrence in subjects with unprovoked VTE who are either carriers or not carriers of congenital thrombophilia.