title: Clotting activation after oral anticoagulant therapy discontinuation: a risk factor for recurrent venous thromboembolism.
abstract: A hypercoagulable state has been reported in some patients treated for venous thromboembolism (VTE) after oral anticoagulant treatment (OAT) discontinuation. It is unclear whether this is a risk factor for thrombosis recurrence. We investigated 139 patients with VTE and followed them up for a median of 20.5 months (6-90 months) to evaluate whether fragment 1 + 2 (F1 + 2) plasma levels are prognostic for VTE recurrence and to confirm clotting activation after OAT withdrawal. Fourteen patients had recurrences during the follow-up. F1 + 2 was measured the day before OAT withdrawal (T0) and 4 weeks later (T1) and its levels were similar in patients with spontaneous VTE versus those with transient risk factors for VTE. F1 + 2 levels increased from T0 to T1 (P < 0.0005). At T1, F1 + 2 values were significantly higher in patients with recurrence than in those without (P < 0.005). The negative predictive value of normal levels of F1 + 2 at T1 was 95%. In carriers of thrombophilic conditions no correlation was found between F1 + 2 levels and VTE recurrence. The results of this study confirm clotting activation after OAT discontinuation and suggest that higher F1 + 2 plasma levels are an independent risk factor for VTE recurrence.
authors.affiliation: Dipartimento di Area Critica Medico Chirurgica, Centro Trombosi, Azienda Ospedaliera Universitaria Careggi, Florence, Italy. polida@ao-careggi.toscana.it
authors.forename: Daniela
authors.initials: D
authors.lastname: Poli
authors.forename: Emilia
authors.initials: E
authors.lastname: Antonucci
authors.forename: Emanuele
authors.initials: E
authors.lastname: Cecchi
authors.forename: Irene
authors.initials: I
authors.lastname: Betti
authors.forename: Ilaria
authors.initials: I
authors.lastname: Lapini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Gazzini
authors.forename: Rosanna
authors.initials: R
authors.lastname: Abbate
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.forename: Domenico
authors.initials: D
authors.lastname: Prisco
mesh_terms: D000328:Adult; D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011516:Prothrombin; D011655:Pulmonary Embolism / Q000175:diagnosis / Q000209:etiology; D012008:Recurrence; D012307:Risk Factors; D013375:Substance Withdrawal Syndrome; D019851:Thrombophilia / Q000139:chemically induced*; D020246:Venous Thrombosis / Q000175:diagnosis* / Q000209:etiology
chemical_list: D000925:Anticoagulants; D010446:Peptide Fragments; C045879:prothrombin fragment 1.2; D011516:Prothrombin