D-dimer levels and recurrence in patients with unprovoked VTE and a negative qualitative D-dimer test after treatment

C Kearon; S Parpia; F.A Spencer; T Baglin; S.M Stevens; K.A Bauer; S.R Lentz; C.M Kessler; J.D Douketis; S Moll; S Kaatz; S Schulman; J.M Connors; J.S Ginsberg; L Spadafora; P.C Liaw; J.I Weitz; J.A Julian

doi:10.1016/j.thromres.2016.06.023

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D-dimer levels and recurrence in patients with unprovoked VTE and a negative qualitative D-dimer test after treatment

Journal article

Peer reviewed

D-dimer levels and recurrence in patients with unprovoked VTE and a negative qualitative D-dimer test after treatment

C Kearon, S Parpia, F.A Spencer, T Baglin, S.M Stevens, K.A Bauer, S.R Lentz, C.M Kessler, J.D Douketis, S Moll, …

Thrombosis research, Vol.146, pp.119-125

10/2016

DOI: 10.1016/j.thromres.2016.06.023

PMID: 27354153

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Abstract

The rate of recurrent venous thromboembolism (VTE) in patients with a first unprovoked VTE who had a negative qualitative D-dimer test one month after stopping anticoagulant therapy was higher than expected in the D-dimer Optimal Duration Study (DODS). To determine whether quantitative D-dimer levels using a low threshold, age- and sex-specific thresholds, or repeated measurements, would improve identification of patients at low risk of recurrent VTE. D-dimer levels were quantified in banked samples from 307 patients in DODS who had a negative qualitative D-dimer test while on, and 1month after stopping, anticoagulant therapy and the rates of recurrent VTE were determined in patients with D-dimer levels below various predefined thresholds. The rate (per patient year) of recurrent VTE was: 5.9% with D-dimer levels<250μg/l at one month; 5.2% with D-dimer levels between 250 and 499μg/l at one month; 5.0% with D-dimer levels less than predefined age- and sex-specific thresholds at one month; and 6.3% when D-dimer levels were <500μg/l at both one and 7months after stopping anticoagulant therapy. These rates are similar to the overall event rate of 6.3% in patients who stopped treatment. Among unprovoked VTE patients who had a negative qualitative D-dimer test during and after anticoagulant therapy, low D-dimer thresholds, age and sex-adjusted thresholds or repeated measurements, did not identify subgroups with a very low rate of recurrence. •Recurrences were high after unprovoked VTE with a negative qualitative D-dimer test.•Low quantitative D-dimer levels might better identify low risk patients.•We assessed very low, sex- and age-specific, and repeated D-dimer levels.•None of these testing strategies were able to identify a very low recurrence risk.

D-dimer

Venous thrombosis

Prognosis

Forecasting

Cohort study

Details

Title: Subtitle: D-dimer levels and recurrence in patients with unprovoked VTE and a negative qualitative D-dimer test after treatment
Creators: C Kearon - McMaster University, Hamilton, Ontario, Canada
S Parpia - McMaster University, Hamilton, Ontario, Canada
F.A Spencer - McMaster University, Hamilton, Ontario, Canada
T Baglin - Addenbrooke's Hospital, Cambridge, UK
S.M Stevens - Intermountain Healthcare
K.A Bauer - Harvard Medical School, Boston, MA, USA
S.R Lentz - University of Iowa, Iowa City, IA, USA
C.M Kessler - Case Western Reserve University
J.D Douketis - McMaster University, Hamilton, Ontario, Canada
S Moll - University of North Carolina, Chapel Hill, NC, USA
S Kaatz - Hurley Medical Center, Flint, MI, USA
S Schulman - McMaster University
J.M Connors - Brigham and Women's Hospital
J.S Ginsberg - McMaster University, Hamilton, Ontario, Canada
L Spadafora - McMaster University, Hamilton, Ontario, Canada
P.C Liaw - McMaster University
J.I Weitz - McMaster University, Hamilton, Ontario, Canada
J.A Julian - McMaster University, Hamilton, Ontario, Canada
Resource Type: Journal article
Publication Details: Thrombosis research, Vol.146, pp.119-125
DOI: 10.1016/j.thromres.2016.06.023
PMID: 27354153
NLM abbreviation: Thromb Res
ISSN: 0049-3848
eISSN: 1879-2472
Publisher: Elsevier Ltd
Grant note: name: Heart and Stroke Foundation of Ontario, award: GIA-50; DOI: 10.13039/501100000024, name: Canadian Institutes of Health Research, award: MOP-84303; DOI: 10.13039/100004411, name: Heart and Stroke Foundation of Canada, award: CI 7438; name: Jack Hirsh Professorship in Thromboembolism; DOI: 10.13039/100008173, name: Intermountain Research and Medical Foundation; DOI: 10.13039/100000002, name: National Institutes of Health, award: HL062984; DOI: 10.13039/100001422, name: American Society of Hematology; name: David Braley and Nancy Gordon Chair; DOI: 10.13039/501100000024, name: Canadian Institutes of Health Research, award: MOP-136878; name: Heart and Stroke Foundation of Ontario, award: GIA-NA6311; name: Canada Research Chair (Tier I) in Thrombosis; DOI: 10.13039/100004411, name: Heart and Stroke Foundation
Language: English
Date published: 10/2016
Academic Unit: Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
Record Identifier: 9984094539402771

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