Journal article
d-Dimer Testing to Select Patients With a First Unprovoked Venous Thromboembolism Who Can Stop Anticoagulant Therapy: A Cohort Study
Annals of internal medicine, Vol.162(1), pp.27-U167
01/06/2015
DOI: 10.7326/M14-1275
PMID: 25560712
Abstract
Background:
Normal d-dimer levels after withdrawal of anticoagulant therapy are associated with a reduced risk for recurrence in patients with unprovoked venous thromboembolism (VTE) and may justify stopping treatment.
Objective:
To determine whether patients with a first unprovoked VTE and negative d-dimer test result who stop anticoagulant therapy have a low risk for recurrence.
Design:
Prospective management study with blinded outcome assessment. (ClinicalTrials.gov: NCT00720915)
Setting:
13 university-affiliated clinical centers.
Patients:
410 adults aged 75 years or younger with a first unprovoked proximal deep venous thrombosis or pulmonary embolism who had completed 3 to 7 months of anticoagulant therapy.
Intervention:
Anticoagulant therapy was stopped if d-dimer test results were negative and was not restarted if results were still negative after 1 month.
Measurements:
Recurrent VTE during an average follow-up of 2.2 years.
Results:
In 319 patients (78%) who had 2 negative d-dimer results and did not restart anticoagulant therapy, rates of recurrent VTE were 6.7% (95% CI, 4.8% to 9.0%) per patient-year overall (42 of 319), 9.7% (CI, 6.7% to 13.7%) per patient-year in men (33 of 180), 5.4% (CI, 2.5% to 10.2%) per patient-year in women with VTE not associated with estrogen therapy (9 of 81), and 0.0% (CI, 0.0% to 3.0%) per patient-year in women with VTE associated with estrogen therapy (0 of 58) (P = 0.001 for the 3-group comparison).
Limitations:
Imprecision in female subgroups. Results may not be generalizable to different d-dimer assays from the one used in the study.
Conclusion:
The risk for 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 may be low enough to justify stopping therapy in women.
Details
- Title: Subtitle
- d-Dimer Testing to Select Patients With a First Unprovoked Venous Thromboembolism Who Can Stop Anticoagulant Therapy: A Cohort Study
- Creators
- Clive Kearon - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaSteven R Lentz - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaFrederick A Spencer - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaDenis O'Keeffe - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaSameer Parpia - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaSam Schulman - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaTrevor Baglin - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaScott M Stevens - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaScott Kaatz - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaKenneth A Bauer - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaJames D Douketis - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaCraig M Kessler - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaStephan Moll - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaJean M Connors - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaJeffrey S Ginsberg - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaLuciana Spadafora - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North CarolinaJim A Julian - From McMaster University, Hamilton, Ontario, Canada; University of Limerick, Limerick, Ireland; Addenbrooke's Hospital, Cambridge, United Kingdom; Intermountain Medical Center, Murray, Utah; Hurley Medical Center, Flint, Michigan; Harvard Medical School, Boston, Massachusetts; University of Iowa, Iowa City, Iowa; Georgetown University, Washington, DC; and University of North Carolina, Chapel Hill, North Carolinad-Dimer Optimal Duration Study Investigators
- Resource Type
- Journal article
- Publication Details
- Annals of internal medicine, Vol.162(1), pp.27-U167
- DOI
- 10.7326/M14-1275
- PMID
- 25560712
- ISSN
- 0003-4819
- eISSN
- 1539-3704
- Language
- English
- Date published
- 01/06/2015
- Academic Unit
- Hematology, Oncology, and Blood & Marrow Transplantation; Internal Medicine
- Record Identifier
- 9984094351902771
Metrics
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