D-dimer levels and risk of recurrence following provoked venous thromboembolism: findings from the RIETE registry.
J Intern Med
; 287(1): 32-41, 2020 01.
Article
de En
| MEDLINE
| ID: mdl-31394000
ABSTRACT
BACKGROUND:
Patients with venous thromboembolism (VTE) secondary to transient risk factors may develop VTE recurrences after discontinuing anticoagulation. Identifying at-risk patients could help to guide the duration of therapy.METHODS:
We used the RIETE database to assess the prognostic value of d-dimer testing after discontinuing anticoagulation to identify patients at increased risk for recurrences. Transient risk factors were classified as major (postoperative) or minor (pregnancy, oestrogen use, immobilization or recent travel).RESULTS:
In December 2018, 1655 VTE patients with transient risk factors (major 460, minor 1195) underwent d-dimer measurements after discontinuing anticoagulation. Amongst patients with major risk factors, the recurrence rate was 5.74 (95% CI 3.19-9.57) events per 100 patient-years in those with raised d-dimer levels and 2.68 (95% CI 1.45-4.56) in those with normal levels. Amongst patients with minor risk factors, the rates were 7.79 (95% CI 5.71-10.4) and 3.34 (95% CI 2.39-4.53), respectively. Patients with major risk factors and raised d-dimer levels (n = 171) had a nonsignificantly higher rate of recurrences (hazard ratio [HR] 2.14; 95% CI 0.96-4.79) than those with normal levels. Patients with minor risk factors and raised d-dimer levels (n = 382) had a higher rate of recurrences (HR 2.34; 95% CI 1.51-3.63) than those with normal levels. On multivariate analysis, raised d-dimers (HR 1.74; 95% CI 1.09-2.77) were associated with an increased risk for recurrences in patients with minor risk factors, not in those with major risk factors.CONCLUSIONS:
Patients with raised d-dimer levels after discontinuing anticoagulant therapy for VTE provoked by a minor transient risk factor were at an increased risk for recurrences.Mots clés
Texte intégral:
1
Collection:
01-internacional
Base de données:
MEDLINE
Sujet principal:
Récidive
/
Produits de dégradation de la fibrine et du fibrinogène
/
Thromboembolisme veineux
Type d'étude:
Diagnostic_studies
/
Etiology_studies
/
Prognostic_studies
/
Risk_factors_studies
Limites:
Female
/
Humans
/
Male
/
Middle aged
Langue:
En
Journal:
J Intern Med
Sujet du journal:
MEDICINA INTERNA
Année:
2020
Type de document:
Article
Pays d'affiliation:
Israël