Predictive Value of D-Dimer Test for Recurrent Venous Thromboembolism After Anticoagulation Withdrawal in Subjects With a Previous Idiopathic Event and in Carriers of Congenital Thrombophilia

Palareti, Gualtiero; Legnani, Cristina; Cosmi, Benilde; Valdrè, Lelia; Lunghi, Barbara; Bernardi, Francesco; Coccheri, S.

doi:10.1161/01.cir.0000079162.69615.0f

Cited by 256 publications

(225 citation statements)

References 29 publications

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“…Earlier prospective studies in patients with VTE [9][10][11][12] demonstrated that D-dimer levels have a strong predictive value for the occurrence of subsequent episodes. These studies suggested that D-dimer measurement may have a role in gauging the duration of anticoagulation in patients with VTE.…”

Section: Introductionmentioning

confidence: 99%

Different cut-off values of quantitative D-dimer methods to predict the risk of venous thromboembolism recurrence: a post-hoc analysis of the PROLONG study

et al. 2008

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Section: Introductionmentioning

confidence: 99%

Different cut-off values of quantitative D-dimer methods to predict the risk of venous thromboembolism recurrence: a post-hoc analysis of the PROLONG study

et al. 2008

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“…In a study of 599 patients, elevated Ddimer levels were found in 37% of individuals after discontinuing anticoagulation. 17 The probability of recurrence 2 years later was the highest (18%) in those patients with unprovoked DVT. In the PREVENT study, presence of a ddimer level of greater than 500 ng/mL 7 weeks post cessation of anticoagulation was associated with a 2-fold risk of recurrence.…”

Section: D-dimer Levelsmentioning

confidence: 95%

Management of Hereditary Hypercoagulable Disorders

Bockenstedt¹

2006

Hematology

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The clinical management of individuals with hereditary hypercoaguable disorders has evolved from initial broad recommendations of lifelong anticoagulation after first event of venous thromboembolism to a more intricate individualized risk-benefit analysis as studies have begun to delineate the complexity of interactions of acquired and hereditary factors which determine the predilection to thrombosis. The contribution of thrombophilic disorders to risk of thrombotic complications of pregnancy, organ transplantation, central venous catheter and dialysis access placement have been increasingly recognized. The risk of thrombosis must be weighed against risk of long-term anticoagulation in patients with venous thromboembolism. Thrombophilia screening in select populations may enhance outcome. Initial DecisionsThe clinical management of individuals with hereditary hypercoagulable disorders has evolved from initial broad recommendations of lifelong anticoagulation after first event of venous thromboembolism (VTE) to a more intricate, individualized risk-benefit analysis as the complexity of interactions of acquired and hereditary factors that determine the predilection to thrombosis are now recognized. Important behind stratifying risk of recurrent events is the necessity of correctly identifying hereditary thrombophilic disorders, especially in circumstances in which laboratory results, e.g., mildly low antithrombin III (ATIII) or protein S levels, may be more indicative of a temporary acquired deficiency. The relevance of thrombophilic testing is debated, but most clinicians agree that prothrombotic assessment should be considered in individuals with unprovoked thrombosis at age less than 40 years, individuals who have had thrombosis at an unusual anatomic site or who have had repeated thromboses, or when the family history suggests multiple affected individuals. For review of the laboratory assessment of thrombophilia see references [1][2][3] . The following discussion is not meant to be comprehensive, but serves to highlight a few of the clinical management decisions important in the care of the thrombophilic patient. Therapeutic considerations involving individuals with antiphospholipid syndrome (APS) will be included where pertinent. Duration of anticoagulant therapyThe decision to extend therapy beyond 6-12 months after an incident thrombotic event must be made on an individual basis. Patients with a transient risk factor such as oral contraceptive use, postsurgical state or limb immobilization have a low risk of recurrence of thrombosis once anticoagulation has been completed. (For review see 4,5 .) Identifying the individual with moderate to high risk of recurrent thrombosis is important to prevent the unnecessary risk of hemorrhage from long-term anticoagulation. From studies of patients with a first VTE (both with and without diagnosed hereditary thrombophilia), one third of patients with unprovoked VTE will have a reoccurrence over the next 10 years and 6% of patients with VTE develop postphlebitic syndrom...

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“…[27][28][29] Increased D-dimer levels were associated with a higher risk of subsequent recurrence. However, it is not yet known whether D-dimer levels or residual venous thrombosis have a role in adjusting the duration of oral anticoagulant therapy.…”

Section: Vitamin K Antagonistsmentioning

confidence: 97%