title: Duration of anticoagulation after isolated pulmonary embolism.
abstract: In the D-dimer and ULtrasonography in Combination Italian Study (DULCIS), serial D-dimer measurement in combination with assessment of residual thrombosis (in patients with deep vein thrombosis (DVT)) identified patients who safely discontinued anticoagulation after an unprovoked venous thromboembolism (VTE).In this subgroup analysis, the value of D-dimer tests was assessed in patients with isolated pulmonary embolism (PE) compared with those with DVT, with or without PE (DVT/PE). The DULCIS database was reanalysed in relation to this target.26.8% of the DULCIS patients had isolated PE as the index event; this was more prevalent in females (34.1%) than in males (21.1%; p<0.0001). The rate of positive D-dimer was similar in isolated PE and DVT/PE. The rate of recurrences was not different in isolated PE or DVT/PE patients (4.8% ppy versus 3.8% ppy; nonsignificant) who stopped anticoagulation for negative D-dimer, but it was markedly high (11.2% ppy; p<0.0001) in those with isolated PE who remained without anticoagulation despite positive D-dimer. Recurrences were more frequently new isolated PE in patients with isolated PE than with DVT/PE (six (46.2%) out of 13 versus two (7.4%) out of 27; p=0.0085).Serial D-dimer assessment can inform on the risk of recurrent VTE and help determine the duration of anticoagulation in patients with isolated PE.
authors.affiliation: Italian Association of Anticoagulated Patients, Bologna Section, Cardiovascular Diseases, University of Bologna, Bologna, Italy gualtiero.palareti@unibo.it.
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: Fondazione Arianna Anticoagulazione, Bologna, Italy.
authors.forename: Emilia
authors.initials: E
authors.lastname: Antonucci
authors.affiliation: Angiology and Blood Coagulation, University Hospital of Bologna, Bologna, Italy.
authors.forename: Cristina
authors.initials: C
authors.lastname: Legnani
authors.affiliation: Haemostasis and Thrombosis Centre, Hospital of Lecco, Lecco, Italy.
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Erba
authors.affiliation: Internal Medicine, Arcispedale Santa Maria Nuova (ASMN), IRCCS, Reggio Emilia, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Ghirarduzzi
authors.affiliation: Thrombosis Centre, Dept of 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.
authors.forename: Alberto
authors.initials: A
authors.lastname: Tosetto
authors.affiliation: Dept of Cardiothoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Pengo
authors.affiliation: Vascular Medicine, Dept of Cardiovascular Sciences, University Hospital of Padua, Padua, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Prandoni
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage*; D001777:Blood Coagulation; D015992:Body Mass Index; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015995:Prevalence; D011446:Prospective Studies; D011655:Pulmonary Embolism / Q000188:drug therapy*; D012307:Risk Factors; D012737:Sex Factors; D015912:Thrombolytic Therapy; D054556:Venous Thromboembolism / Q000188:drug therapy*; D020246:Venous Thrombosis / Q000188:drug therapy
chemical_list: D000925:Anticoagulants; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D