title: Residual venous obstruction, alone and in combination with D-dimer, as a risk factor for recurrence after anticoagulation withdrawal following a first idiopathic deep vein thrombosis in the prolong study.
abstract: OBJECTIVE
  This study aims to assess the predictive value of residual venous obstruction (RVO) for recurrent venous thrombo-embolism (VTE) in a study using D-dimer to predict outcome.
  
  
  METHODS
  This is a multicentre randomised open-label study.
  
  
  METHODS
  Patients with a first episode of idiopathic VTE were enrolled on the day of anticoagulation discontinuation when RVO was determined by compression ultrasonography in those with proximal deep vein thrombosis (DVT) of the lower limbs. D-dimer was measured after 1 month. Patients with normal D-dimer did not resume anticoagulation while patients with abnormal D-dimer were randomised to resume anticoagulation or not. The primary outcome measure was recurrent VTE over an 18-month follow-up.
  
  
  RESULTS
  A total of 490 DVT patients were analysed (after excluding 19 for different reasons and 118 for isolated pulmonary embolism (PE)). Recurrent DVT occurred in 19% (19/99) of patients with abnormal D-dimer who did not resume anticoagulation and 10% (31/310) in subjects with normal D-dimer (adjusted hazard ratio: 2.1; p = 0.02). Recurrences were similar in subjects either with (11%, 17/151) or without RVO (13%, 32/246). Recurrent DVT rates were also similar for normal D-dimer, with or without RVO, and for abnormal D-dimer, with or without RVO.
  
  
  CONCLUSIONS
  Elevated D-dimer at 1 month after anticoagulation withdrawal is a risk factor for recurrence, while RVO at the time of anticoagulation withdrawal is not.
authors.affiliation: Department of Angiology & Blood Coagulation Marino Golinelli, University Hospital S. Orsola-Malpighi, Via Albertoni, 15 Bologna, Italy. benilde.cosmi@unibo.it
authors.forename: B
authors.initials: B
authors.lastname: Cosmi
authors.forename: C
authors.initials: C
authors.lastname: Legnani
authors.forename: A
authors.initials: A
authors.lastname: Iorio
authors.forename: V
authors.initials: V
authors.lastname: Pengo
authors.forename: A
authors.initials: A
authors.lastname: Ghirarduzzi
authors.forename: S
authors.initials: S
authors.lastname: Testa
authors.forename: D
authors.initials: D
authors.lastname: Poli
authors.forename: A
authors.initials: A
authors.lastname: Tripodi
authors.forename: G
authors.initials: G
authors.lastname: Palareti
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage*; D015415:Biomarkers / Q000097:blood; D004334:Drug Administration Schedule; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012008:Recurrence; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D015854:Up-Regulation; D054556:Venous Thromboembolism / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality; D020246:Venous Thrombosis / Q000097:blood / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000401:mortality
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D