Journal article
Long-term risk of recurrence in patients with a first unprovoked venous thromboembolism managed according to d-dimer results; A cohort study
Journal of thrombosis and haemostasis, Vol.17(7), pp.1144-1152
07/01/2019
DOI: 10.1111/jth.14458
PMID: 31033194
Abstract
Essentials
Long-term recurrence risk after a first unprovoked VTE with negative d-dimer levels is uncertain. Anticoagulation was stopped if d-dimer was negative, and was continued if d-dimer was positive. Five years after stopping anticoagulants, recurrent VTE was 30% in men and 17% in women. Negative d-dimers do not justify stopping anticoagulants in most men but appear to in most women. Background The long-term risk of recurrence in patients with a first unprovoked venous thromboembolism (VTE) who have negative d-dimer results is uncertain. Objectives To determine this risk, including in subgroups based on sex. Patients and methods ln a prospective interventional cohort study of 410 patients with a first unprovoked VTE, anticoagulants were stopped if d-dimer was negative on therapy and 1 month after stopping therapy. Other patients remained on anticoagulant therapy. We previously reported findings after a mean of 2.2 years. The current report includes 3 years of additional follow-up in 293 of these patients. Results During a median follow-up of 5.0 years, recurrent VTE after stopping therapy in response to negative d-dimer testing was 5.1% (95% confidence interval [CI], 3.6-6.5) per patient-year overall, 7.5% (95% CI, 5.5-10.0) in men, 3.8% (95% CI, 2.0-6.6) in women with VTE not associated with estrogens, and 0.4% (95% CI, 0.0-2.3) in women with VTE associated with estrogens (P < 0.001 for three-group comparison). Risk of recurrence at 5 years was 21.5% (95% CI, 16.4-26.5) overall, 29.7% (95% CI, 22.1-37.3) in men, 17.0% (95% CI, 8.1-25.9) in non-estrogen women, and 2.3% (95% CI, 0.0-6.8) in estrogen women. Conclusion The long-term risk of recurrence in patients with a first unprovoked VTE who have negative d-dimer results is not low enough to justify stopping anticoagulant therapy in men, but appears to be low enough in women for many to choose stopping therapy (ClinicalTrials.gov; NCT 00720915).
Details
- Title: Subtitle
- Long-term risk of recurrence in patients with a first unprovoked venous thromboembolism managed according to d-dimer results; A cohort study
- Creators
- Clive Kearon - McMaster UniversitySameer Parpia - McMaster UniversityFrederick A. Spencer - McMaster UniversitySam Schulman - McMaster UniversityScott M. Stevens - Intermountain Medical CenterVinay Shah - Henry Ford HospitalKenneth A. Bauer - Harvard UniversityJames D. Douketis - McMaster UniversitySteven R. Lentz - University of IowaCraig M. Kessler - Georgetown UniversityJean M. Connors - Harvard UniversityJeffrey S. Ginsberg - McMaster UniversityLuciana Spadafora - McMaster UniversityJim A. Julian - McMaster University
- Resource Type
- Journal article
- Publication Details
- Journal of thrombosis and haemostasis, Vol.17(7), pp.1144-1152
- Publisher
- Wiley
- DOI
- 10.1111/jth.14458
- PMID
- 31033194
- ISSN
- 1538-7933
- eISSN
- 1538-7836
- Number of pages
- 9
- Grant note
- MOP-84303; MOP-126098 / Canadian Institutes of Health Research; Canadian Institutes of Health Research (CIHR)
- Language
- English
- Date published
- 07/01/2019
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984359942302771
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