Usefulness of repeated D-dimer testing after stopping anticoagulation for a first episode of unprovoked venous thromboembolism: the PROLONG II prospective study

Cosmi, Benilde; Legnani, Cristina; Tosetto, Alberto; Pengo, Vittorio; Ghirarduzzi, Angelo; Testa, Sophie; Prisco, Domenico; Poli, Daniela; Tripodi, Armando; Marongiu, Francesco; Palareti, Gualtiero

doi:10.1182/blood-2009-08-237354

Cited by 132 publications

(72 citation statements)

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“…Biomarkers associated with coagulation and inflammation may play a role in the resolution of thrombosis [26,27]. Cosmi et al [28] demonstrated that repeated D-dimer testing after cessation of anticoagulant therapy for the first episode of unprovoked VTE could help determine the duration of the treatment. Montes-Worboys et al showed that elevated levels of D-dimer after 3 months had a negative correlation with improvement of popliteal residual thrombosis.…”

Section: Discussıonmentioning

confidence: 99%

Value of Platelet Indices in Identifying Complete Resolution of Thrombus in Deep Venous Thrombosis Patients

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et al. 2014

Indian J Hematol Blood Transfus

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We aimed to evaluate whether mean platelet volume (MPV) and platelet distribution width (PDW) are helpful to identify complete thrombus resolution (CTR) after acute deep venous thrombosis (DVT). Patients who had first-time episode of acute proximal DVT were included in this retrospective study. 100 patients with DVT were divided into two groups according to absence (group 1; n = 68) or presence (group 2; n = 32) of CTR on doppler ultrasonography at month 6. There were no significant difference in admission MPV and PDW levels between group 1 and group 2. MPV (p = 0.03) and PDW (p \ 0.001) levels at month 6 were significantly higher in group 1 than in group 2. CTR showed a moderate negative correlation with PDW at month 6 (q = -0.47) and a weak negative correlation with MPV at month 6 (q = -0.26). Logistic regression analysis showed that PDW (OR, 2.2; p = 0.004) at month 6 was an independent risk factor for the presence of residual venous thrombosis in DVT patients. Receiver operating characteristics analysis revealed that a 8.4 % decrease in admission MPV at month 6 provided 62 % sensitivity and 62 % specificity (AUC: 0.64) and a 15.4 % decrease in admission PDW at month 6 provided 87 % sensitivity and 94 % specificity (AUC: 0.89) for prediction of CTR in DVT patients. Percent change in admission MPV and PDW levels at month 6 may be used to identify the patients with CTR after a first episode of acute proximal DVT.

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Section: Discussıonmentioning

confidence: 99%

Value of Platelet Indices in Identifying Complete Resolution of Thrombus in Deep Venous Thrombosis Patients

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et al. 2014

Indian J Hematol Blood Transfus

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“…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].…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2011

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The safest duration of anticoagulation after idiopathic deep vein thrombosis (DVT) is unknown. We conducted a prospective study to assess the optimal duration of vitamin K antagonist (VKA) therapy considering the risk of recurrence of thrombosis according to residual vein thrombosis (RVT). Patients with a first unprovoked DVT were evaluated for the presence of RVT after 3 months of VKA administration; those without RVT suspended VKA, while those with RVT continued oral anticoagulation for up to 2 years. Recurrent thrombosis and/or bleeding events were recorded during treatment (RVT group) and 1 year after VKA withdrawal (both groups). Among 409 patients evaluated for unprovoked DVT, 33.2% (136 of 409 patients) did not have RVT and VKA was stopped. The remaining 273 (66.8%) patients with RVT received anticoagulants for an additional 21 months; during this period of treatment, recurrent venous thromboembolism and major bleeding occurred in 4.7% and 1.1% of patients, respectively. After VKA suspension, the rates of recurrent thrombotic events were 1.4% and 10.4% in the no-RVT and RVT groups, respectively (relative risk 5 7.4; 95% confidence interval 5 4.9-9.9). These results indicate that in patients without RVT, a short period of treatment with a VKA is sufficient; in those with persistent RVT, treatment extended to 2 years substantially reduces, but does not eliminate, the risk of recurrent thrombosis. Am. J. Hematol. 86:914-917, 2011. V

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“…This group performed a follow-up study in which they repeated D-dimer testing every 2 months for 1 year in patients with a normal D-dimer 1 month after stopping anticoagulation. 30 Among patients in whom D-dimer became positive at the third month and remained abnormal thereafter, the recurrence risk was 27% per year (7 events in 31 patients). Although data suggest that repeated D-dimer testing could further tailor decisions regarding the risk of recurrence and the need for resuming anticoagulation, these findings require confirmation.…”

Section: Clinical Vignette: a 52-year-old Male Presented With An Unprmentioning

confidence: 99%

Duration of Anticoagulation: Applying the Guidelines and Beyond

Bauer

2010

Hematology

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Despite an improved understanding of the risk factors underlying venous thromboembolism (VTE), extensive clinical investigation, and detailed clinical guidelines, the decision to extend anticoagulation indefinitely for an individual patient with VTE is often problematic. Patients with VTE in association with major surgery, trauma, immobilization, or pregnancy are at relatively low risk of recurrence and generally do not require more than 3 to 6 months of anticoagulant therapy. For patients with a first unprovoked, or idiopathic, episode of VTE, an individualized approach should be taken in deciding on the duration of anticoagulation based on the patient's recurrence and bleeding risk, as well as their personal preference. Although the presence of genetic thrombophilic disorders (factor V Leiden and prothrombin G20210A gene mutations; deficiencies of antithrombin, protein C, and protein S) predispose patients to a first episode of VTE, there is inconsistent data on whether testing for these defects changes patient outcomes or should alter their management. In patients with a single unprovoked VTE, measurement of D-dimer several weeks following the completion of anticoagulant therapy appears useful in stratifying patients with a first unprovoked episode of VTE with regard to recurrence risk. Through a series of clinical vignettes, the utility of the laboratory in risk-stratifying patients with respect to recurrence risk will be discussed, along with decision making regarding the duration of anticoagulation. The potential impact of having a nonremovable inferior vena caval filter will also be addressed.

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Usefulness of repeated D-dimer testing after stopping anticoagulation for a first episode of unprovoked venous thromboembolism: the PROLONG II prospective study

Cited by 132 publications

References 21 publications

Value of Platelet Indices in Identifying Complete Resolution of Thrombus in Deep Venous Thrombosis Patients

Value of Platelet Indices in Identifying Complete Resolution of Thrombus in Deep Venous Thrombosis Patients

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

Duration of Anticoagulation: Applying the Guidelines and Beyond

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