D-dimer testing to determine the duration of anticoagulation therapy

Abstract

women with sphingomyelin levels of Ն60 mg/dL than in women with sphingomyelin levels of Ͻ39 mg/dL. This association did not remain significant after multivariant adjustment for standard cardiovascular risk factors. Men with sphingomyelin levels of Ͼ60 mg/dL had higher calcium scores (135 vs 99 Agatston units, P ϭ .01) than men with sphingomyelin levels Ͻ39 mg/dL. Comment: Sphingomyelin accumulates in atheromas in animal models and in human atheroma. Much sphingomyelin found in arteries arises from synthesis within the arterial tissue (Circulation 1961;23:370-5). However, synthesis of sphingomyelin within arterial tissue appears slow compared with the total amount accumulated, suggesting plasma levels of sphingomyelin may also contribute to accumulation of sphingomyelin within arterial tissue. The unadjusted data from this study provide some support that plasma sphingomyelin is a component of a pathway that mediates risk for subclinical disease attributable to traditional cardiovascular risk factors.

The negative predictive value of D‐dimer on the risk of recurrent venous thromboembolism in patients with multiple previous events: A prospective cohort study (the PROLONG PLUS study)

“…In comparison with all previous studies on D-dimer in patients with a single VTE event [3][4][5]7], we observed a lower rate of patients with normal D-dimer at 30 days, a higher rate of recurrences in the first month of the study, and a slightly higher annual rate of VTE recurrences when comparing the groups of patients with negative D-dimer at 30 days.…”

“…The PROLONG study has previously evaluated the predictive role of Ddimer measurement after withholding VKA treatment in patients with a first episode of unprovoked VTE [5]. Patients with a positive D-dimer 1 month after the discontinuation of anticoagulation who were not restarted on VKA treatment had a significantly higher incidence of VTE recurrences than patients with a negative D-dimer (10.9 events per 100 patient/years and 4.4 events per 100 patient/years, respectively).…”

Residual vein thrombosis for assessing duration of anticoagulation after unprovoked deep vein thrombosis of the lower limbs: The extended DACUS study

“…RVT assessment is an easy method, does not seem to be influenced by the aforementioned conditions, but requires some expertise and is, to a certain extent, a subjective technique. A very important issue is the fact that these tools can identify patients carrying a low risk for recurrent VTE; these patients, in fact, may safely benefit from a short course (3 months) of VKA treatment [7][8][9]. Concerning RVT specifically, the absence of a residual clot is associated with a negligible risk for recurrent VTE; this may allow a short course of VKA in about one-third of the entire DVT patient population.…”

“…Among these, D-dimer (D-d) assay and residual vein thrombosis (RVT), detected by compression ultrasonography (C-US), have shown to be the most suitable methods for assessing the optimal duration of VKA administration. In fact, a number of studies have shown that negative results with these parameters after 3-6 months of therapy can identify a group of patients at low-risk for recurrent thrombosis in whom VKA treatment can be stopped [7][8][9][10]. However, these previous investigations have some limitations; first, in some trials, 30% of the patient population had provoked DVT [8,9].…”

“…However, these previous investigations have some limitations; first, in some trials, 30% of the patient population had provoked DVT [8,9]. In addition, no clear indications were given for how long patients with persistent RVT or positive D-dimer should be treated, since a significant risk for recurrent VTE persists even after 1 year of anticoagulation [7][8][9]. In fact, none of these studies has offered clear results regarding assessment of the optimal duration of VKA treatment, even after the analysis of pooled data [11,12].…”