Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland.
CTU Bern, University of Bern, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Switzerland.
Am J Med. 2017 Oct;130(10):1221-1224. doi: 10.1016/j.amjmed.2017.04.018. Epub 2017 May 15.
Whether post-anticoagulation D-dimer levels are useful in predicting recurrence in elderly patients with unprovoked venous thromboembolism is unknown.
We followed up 157 patients aged ≥65 years with acute symptomatic, unprovoked venous thromboembolism in a prospective, multicenter cohort study. All patients completed 3-12 months of anticoagulation and then underwent quantitative D-dimer testing (enzyme-linked immunosorbent assay) 12 months after the index venous thromboembolism. The outcome was recurrent symptomatic venous thromboembolism after D-dimer measurement. We examined associations between log-transformed and dichotomized D-dimer values and the time to venous thromboembolism recurrence using competing risk regression, adjusting for age, sex, and overt pulmonary embolism.
There was no statistically significant association between quantitative or dichotomized D-dimer levels and venous thromboembolism recurrence. The area under the receiver operating characteristic curve for predicting recurrent venous thromboembolism was moderate (0.66; 95% confidence interval [CI], 0.51-0.82). The negative likelihood ratios were 0.34 (95% CI, 0.05-2.38) at the usual and 0.34 (95% CI, 0.09-1.29) at the age-adjusted cutoff values. Among patients with normal D-dimer results, venous thromboembolism recurrence rates were 6.8 (95% CI, 2.2-21.2) per 100 patient-years using the usual and 7.1 (95% CI, 3.2-15.8) per 100 patient-years using the age-adjusted cutoff values.
D-dimer testing alone may not be useful in identifying elderly patients with unprovoked venous thromboembolism who are at low risk of recurrent venous thromboembolism and in whom anticoagulants may be safely stopped.
对于无诱因静脉血栓栓塞症的老年患者，抗凝治疗后 D-二聚体水平是否可用于预测复发尚不清楚。
我们前瞻性地随访了 157 例年龄≥65 岁的急性有症状的、无诱因静脉血栓栓塞症患者，这些患者来自多中心队列研究。所有患者完成了 3-12 个月的抗凝治疗，然后在静脉血栓栓塞症发作后 12 个月进行定量 D-二聚体检测（酶联免疫吸附试验）。主要终点是 D-二聚体检测后有症状的静脉血栓栓塞症复发。我们使用竞争风险回归分析，在校正年龄、性别和显性肺栓塞后，分析了 D-二聚体值的对数转换值和二分法 D-二聚体值与静脉血栓栓塞症复发时间之间的关系。
定量或二分法 D-二聚体水平与静脉血栓栓塞症复发之间无统计学显著相关性。预测静脉血栓栓塞症复发的受试者工作特征曲线下面积为中等（0.66；95%置信区间[CI]，0.51-0.82）。阴性似然比在常规和年龄校正截断值分别为 0.34（95%CI，0.05-2.38）和 0.34（95%CI，0.09-1.29）。在 D-二聚体正常的患者中，使用常规截断值和年龄校正截断值，静脉血栓栓塞症复发率分别为每 100 患者-年 6.8（95%CI，2.2-21.2）和每 100 患者-年 7.1（95%CI，3.2-15.8）。
单独的 D-二聚体检测可能无法识别无诱因静脉血栓栓塞症的老年患者，这些患者发生静脉血栓栓塞症复发的风险较低，可安全停用抗凝药物。
