K.G. Jebsen Thrombosis Research and Expertise Center, Department of Clinical Medicine, UiT - The Arctic University of Norway, Tromsø, Norway.
Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway.
J Thromb Haemost. 2017 May;15(5):917-924. doi: 10.1111/jth.13648. Epub 2017 Feb 24.
Essentials Whether D-dimer at incident venous thromboembolism (VTE) can predict recurrence-risk is unknown. We explored this association in 454 cancer-free patients with a first lifetime VTE. A low D-dimer at first VTE diagnosis was associated with a low recurrence risk. The association was predominant in patients with deep vein thrombosis and unprovoked VTE. Click to hear Dr Cannegieter's presentation on venous thrombosis: prediction of recurrence SUMMARY: Background Venous thromboembolism (VTE) is a common disease with a high recurrence rate. D-dimer measured after cessation of anticoagulant therapy predicts recurrence, and is used to decide on treatment prolongation. However, whether D-dimer measured at first VTE diagnosis can be used to assess recurrence-risk is unknown. Aims To investigate the association between D-dimer, measured at first VTE diagnosis and risk of recurrent VTE. Methods Information on clinical risk factors and laboratory markers were collected in 454 cancer-free patients with a first VTE. Recurrent VTEs and deaths during follow-up (1994-2012) were recorded. Results During a median follow-up of 3.9 years, 84 patients experienced a recurrent VTE. The crude recurrence rate was 1.7 (95% confidence interval [CI], 1.0-2.9) per 100 person-years in the lower quartile of D-dimer (≤ 1500 ng mL ), and 4.9 (95% CI, 3.9-6.1) per 100 person-years in the upper three quartiles combined, yielding an absolute risk difference of 3.2 per 100 person-years. Patients with D-dimer ≤ 1500 ng mL had 54% lower recurrence-risk than patients with D-dimer > 1500 ng mL (HR, 0.46; 95% CI, 0.25-0.82). The association was particularly pronounced among patients with unprovoked events and deep vein thrombosis, showing a 66% (HR, 0.34; 95% CI, 0.15-0.74) and 68% (HR, 0.32; 95% CI, 0.14-0.71) lower recurrence risk among patients with D-dimer ≤ 1500 ng mL , respectively. Conclusions A low D-dimer (≤ 1500 ng mL ) measured at first VTE diagnosis was associated with a low recurrence risk, particularly among patients with DVT and unprovoked events. Our findings suggest that a clinical decision to avoid prolonged anticoagulant treatment could be considered based on low D-dimer at the time of VTE diagnosis.
无论在首发静脉血栓栓塞症（VTE）时检测 D-二聚体能否预测复发风险尚不清楚。我们在 454 例无癌症的首发 VTE 患者中对此相关性进行了探索。首次 VTE 诊断时 D-二聚体较低与较低的复发风险相关。该相关性在深静脉血栓形成和无诱因 VTE 患者中占主导地位。点击听取 Cannegieter 博士关于静脉血栓形成的演讲：复发风险的预测 概要：背景 静脉血栓栓塞症（VTE）是一种常见疾病，复发率较高。在停止抗凝治疗后测量 D-二聚体可预测复发，并用于决定延长治疗。然而，在首次 VTE 诊断时测量 D-二聚体是否可用于评估复发风险尚不清楚。 目的 研究首发 VTE 时测量的 D-二聚体与复发性 VTE 风险之间的关系。 方法 在 454 例无癌症的首发 VTE 患者中收集了临床危险因素和实验室标志物信息。记录随访期间（1994-2012 年）的复发性 VTE 和死亡。 结果 在中位随访 3.9 年期间，84 例患者发生了复发性 VTE。在 D-二聚体（≤1500ng/ml）较低四分位数（84 例患者中有 17 例）中，未经治疗的 VTE 复发率为 1.7（95%置信区间[CI]，1.0-2.9），而在 D-二聚体较高三分位数（>1500ng/ml）中，未经治疗的 VTE 复发率为 4.9（95%CI，3.9-6.1），每个 100 人年的绝对风险差异为 3.2。D-二聚体水平≤1500ng/ml 的患者与 D-二聚体水平>1500ng/ml 的患者相比，复发风险低 54%（HR，0.46；95%CI，0.25-0.82）。在无诱因事件和深静脉血栓形成患者中，这种相关性更为明显，D-二聚体水平≤1500ng/ml 的患者复发风险分别降低了 66%（HR，0.34；95%CI，0.15-0.74）和 68%（HR，0.32；95%CI，0.14-0.71）。 结论 在首发 VTE 时测量的 D-二聚体（≤1500ng/ml）较低与较低的复发风险相关，尤其是在 DVT 和无诱因事件患者中。我们的研究结果表明，基于 VTE 诊断时的低 D-二聚体水平，可考虑避免延长抗凝治疗。
