D-Dimer Levels and Risk of Recurrent Venous Thromboembolism

摘要: ContextWidespread screening of patients with venous thromboembolism (VTE) for thrombophilic risk factors has become common clinical practice. Because of the increasing number factors, assessing the recurrence in an individual patient is intricate; therefore, a laboratory method that measures multifactorial thrombophilia required.ObjectiveTo prospectively study relationship between recurrent VTE and D-dimer, global marker coagulation activation fibrinolysis.Design, Setting, ParticipantsProspective cohort 610 older than 18 years who were treated oral anticoagulants for at least 3 months first spontaneous VTE, in whom D-dimer levels were measured shortly after discontinuation of oral anticoagulation. The was conducted Department Internal Medicine I, University Hospital, Vienna, Austria. Patients entered study at time observed 3-month intervals during year every 6 thereafter from July 1992 to October 2002.Main Outcome MeasureObjectively documented symptomatic recurrent VTE.ResultsA total 79 (13%) had VTE mean observation time 38 months. significantly higher D-dimer levels compared those without (553 ng/mL vs 427 ng/mL, P = .01). Compared of 750 or higher, relative (RR) 0.6 (95% confidence interval [CI], 0.3-1.4), CI, 0.3-1.2), 0.3 0.1-0.6) in 500 to 749 250 499 and less respectively. cumulative probability 2 3.7% 0.9%-6.5%) among levels of less 11.5% 8.0%-15.0%) patients with (P .001). 60% lower RR with patients (RR, 0.4; 95% 0.2-0.8).ConclusionPatients spontaneous level than 250 withdrawal anticoagulation have low VTE recurrence.