[D-dimers measurement to predict the risk of thromboembolic recurrence].
OBJECTIVE
The optimal duration of anticoagulant therapy after a first episode of venous thromboembolism (VTE) is still matter of debate. Currently, the duration of anticoagulation is recommended on the basis of the clinical characteristics of the index event. In particular, the seventh ACCP conference on antithrombotic and thrombolytic therapy suggests that events secondary to a reversible risk factor should anticoagulated for shorter period of time than idiopathic VTE. Recently, D-dimer measurement has been used to predict the risk of recurrence and to tailor anticoagulant therapy on an individual basis.


BACKGROUND
Four studies used various D-dimer tests at various cut-off to predict the risk of recurrence after a first VTE event. Overall, these studies confirmed that D-dimer measurement has a high negative predictive value (>92%) to predict the risk of a recurrent VTE event. One intervention randomized study confirmed that in patients who stopped anticoagulation, the adjusted hazard ratio for a recurrent event among those with an abnormal D-dimer test, as compared with those with a normal test was of 2.27 (95% CI:1.15-4.46).


CONCLUSIONS
The missing gap remains to find a test able to detect patients at high risk of recurrence in whom maintaining anticoagulation would be beneficial. The limited positive predictive value of D-dimer reported in all studies suggests that the D-dimer test will have limited value in this field. Moreover, standardization of the cut-off and of the time of blood sampling in relation to cessation of anticoagulation is warranted.
Righini
M
M
Division d'angiologie et d'hémostase, hôpitaux universitaires de Genève, 24, rue Micheli-du-Crest, 1211 Genève, Suisse. Marc.Righini@hcuge.ch
Perrier
A
A
D000925:Anticoagulants / Q000627:therapeutic use*; D000933:Antifibrinolytic Agents / Q000378:metabolism*; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D054556:Venous Thromboembolism / Q000097:blood* / Q000517:prevention & control*
D000925:Anticoagulants; D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D