title: D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study.
abstract: The optimal duration of anticoagulation in patients with venous thromboembolism (VTE) is uncertain. We investigated whether persistently negative D-dimers in patients with vein recanalization or stable thrombotic burden can identify subjects at low recurrence risk. Outpatients with a first VTE (unprovoked or associated with weak risk factors) were eligible after at least 3 months (12 in those with residual thrombosis) of anticoagulation. They received serial D-dimer measurements using commercial assays with predefined age/sex-specific cutoffs and were followed for up to 2 years. Of 1010 patients, anticoagulation was stopped in 528 (52.3%) with persistently negative D-dimer who subsequently experienced 25 recurrences (3.0% pt-y; 95% confidence interval [CI], 2.0-4.4%). Of the remaining 482 patients, 373 resumed anticoagulation and 109 refused it. Recurrent VTE developed in 15 patients (8.8% pt-y; 95% CI, 5.0-14.1) of the latter group and in 4 of the former (0.7% pt-y; 95% CI, 0.2-1.7; hazard ratio = 2.92; 95% CI, 1.87-9.72; P = .0006). Major bleeding occurred in 14 patients (2.3% pt-y; 95% CI, 1.3-3.9) who resumed anticoagulation. Serial D-dimer measurement is suitable in clinical practice for the identification of VTE patients in whom anticoagulation can be safely discontinued. This study was registered at clinicaltrials.gov as #NCT00954395.
authors.affiliation: Angiology and Blood Coagulation, University Hospital of Bologna, Bologna, Italy;
authors.forename: Gualtiero
authors.initials: G
authors.lastname: Palareti
authors.affiliation: Angiology and Blood Coagulation, University Hospital of Bologna, Bologna, Italy;
authors.forename: Benilde
authors.initials: B
authors.lastname: Cosmi
authors.affiliation: Angiology and Blood Coagulation, University Hospital of Bologna, Bologna, Italy;
authors.forename: Cristina
authors.initials: C
authors.lastname: Legnani
authors.affiliation: Thrombosis Centre, Department Heart and Vessels, University Hospital of Florence, Florence, Italy;
authors.forename: Emilia
authors.initials: E
authors.lastname: Antonucci
authors.affiliation: Haemostasis and Thrombosis Centre, Hospital of Lecco, Lecco, Italy;
authors.forename: Valeria
authors.initials: V
authors.lastname: De Micheli
authors.affiliation: Internal Medicine, ASMN-IRCCS-Reggio Emilia, Reggio nell'Emilia, Italy;
authors.forename: Angelo
authors.initials: A
authors.lastname: Ghirarduzzi
authors.affiliation: Thrombosis Centre, Department Heart and Vessels, University Hospital of Florence, Florence, Italy;
authors.forename: Daniela
authors.initials: D
authors.lastname: Poli
authors.affiliation: Haemostasis and Thrombosis Centre, Hospital of Cremona, Cremona, Italy;
authors.forename: Sophie
authors.initials: S
authors.lastname: Testa
authors.affiliation: Haematology and Thrombosis Centre, Hospital of Vicenza, Vicenza, Italy; and.
authors.forename: Alberto
authors.initials: A
authors.lastname: Tosetto
authors.affiliation: Department of Cardiothoracic and Vascular Sciences and.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Pengo
authors.affiliation: Internal Medicine, Department of Medical and Surgical Sciences, University Hospital of Padua, Padua, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Prandoni
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011247:Pregnancy; D012008:Recurrence; D013997:Time Factors; D016896:Treatment Outcome; D054556:Venous Thromboembolism / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy*; D028761:Withholding Treatment
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D