title: D-Dimer Levels and Vitamin K Antagonist Therapy in Deep Vein Thrombosis of the Legs.
abstract: BACKGROUND
  D-dimer levels are closely related to the clinical status of deep vein thrombosis (DVT). This study aimed to investigate the factors which were associated with the normalization of D-dimer level by vitamin K antagonist (VKA) therapy, the maintenance of normal D-dimer levels for 6 months during VKA therapy, and the recurrent elevations of D-dimer above normal level after VKA withdrawal, in DVT of the legs.
  
  
  METHODS
  The 469 consecutive patients with first-episode leg swelling were examined. All blood tests were measured from the initially sampled blood before the administration of medications.
  
  
  RESULTS
  Of the 469 patients, 288 (61.4%) showed positive D-dimer test. Radiologic examinations, including Doppler ultrasound and computed tomography venography, of the 288 patients revealed positive DVT of the legs in 135 (46.9%) patients and of these, 122 with total follow-up durations of >6 months were enrolled in this study. Linear regression analysis of 100 patients who experienced D-dimer normalization revealed initial D-dimer levels were positively correlated with D-dimer normalization time during VKA therapy (P = 0.010). Logistic regression analysis showed initial D-dimer level was negatively associated with the normalization of D-dimer levels by VKA therapy (P = 0.045), and being a woman (P = 0.005) and having lower protein C (P = 0.002) level had negative impacts on the maintenance of normal D-dimer levels for 6 months during VKA therapy. Finally, after VKA withdrawal, the recurrent elevations of D-dimer above normal level were more likely to occur in women than in men (P = 0.004).
  
  
  CONCLUSIONS
  From these observations, it is suggested that higher initial D-dimer level, lower protein C level, and female gender may be the adverse risk factors for the treatment of DVT of the legs using VKA.
authors.affiliation: Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea. Electronic address: jkpark@paik.ac.kr.
authors.forename: Jong Kwon
authors.initials: JK
authors.lastname: Park
authors.affiliation: Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea.
authors.forename: Do Hoon
authors.initials: do H
authors.lastname: Koo
authors.affiliation: Department of Surgery, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea.
authors.forename: Doo Hwan
authors.initials: DH
authors.lastname: Yoon
authors.affiliation: Department of Laboratory Medicine, Haeundae Paik Hospital, College of Medicine, Inje University, Busan, Republic of Korea.
authors.forename: Jeong Nyeo
authors.initials: JN
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage* / Q000009:adverse effects; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D000072226:Computed Tomography Angiography; D004334:Drug Administration Schedule; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D035002:Lower Extremity / Q000098:blood supply*; D008297:Male; D008875:Middle Aged; D055420:Perfusion Imaging / Q000379:methods; D010690:Phlebography / Q000379:methods; D011237:Predictive Value of Tests; D011486:Protein C / Q000378:metabolism; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D015899:Tomography, Emission-Computed, Single-Photon; D016896:Treatment Outcome; D018608:Ultrasonography, Doppler; D015854:Up-Regulation; D054556:Venous Thromboembolism / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D020246:Venous Thrombosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000188:drug therapy*; D014812:Vitamin K / Q000037:antagonists & inhibitors*; D014859:Warfarin / Q000008:administration & dosage* / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D011486:Protein C; C036309:fibrin fragment D; D014812:Vitamin K; D014859:Warfarin