Fondazione Arianna Anticoagulazione, Bologna, Italy.
Fondazione Ca' Granda (Istituto di Ricovero e Cura a Carattere Scientifico) - Ospedale Maggiore Policlinico - A. Bianchi Bonomi Hemophilia and Thrombosis Center, Milano, Italy.
PLoS One. 2019 Jul 16;14(7):e0219751. doi: 10.1371/journal.pone.0219751. eCollection 2019.
D-dimer levels measured during and after vitamin K antagonist withdrawal may be used in clinical practice to assess the individual risk of recurrent venous thromboembolism. Currently, direct oral anticoagulants (DOACs) are frequently used in venous thromboembolism treatment; however, their pharmacokinetics and pharmacodynamics characteristics are completely different than vitamin K antagonists. The present study aimed at comparing the results of D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with DOACs or warfarin.
D-dimer levels were measured in 527 patients ("cases") during DOACs treatment (T0) and after 15 (T15), 30 (T30), 60 (T60) and 90 (T90) days after their discontinuation and in 527 patients ("controls") enrolled in the DULCIS study (all treated with warfarin), matched for sex, age (+/-3 y), type of D-dimer assay and site of venous thromboembolism. Both cases and controls received anticoagulant treatment after a first venous thromboembolism event that was unprovoked or associated with weak risk factors.
The rate of positive D-dimer results was significantly higher in cases than in controls at T0 (10.8% vs 5.1%, p = 0.002) and at T30 (18.8% vs 11.8%, p = 0.019), as well as at the other time-points, though not statistically significant.
D-dimer levels during and after stopping an anticoagulant treatment for a venous thromboembolism episode differ between patients treated with a DOAC than in those treated with warfarin. Specifically designed prospective studies are warranted to reassess the use of D-dimer as predictor of the risk of recurrent venous thromboembolism in patients treated with DOACs.
在维生素 K 拮抗剂停药期间和之后测量的 D-二聚体水平可用于临床实践中评估静脉血栓栓塞复发的个体风险。目前，直接口服抗凝剂（DOAC）常用于静脉血栓栓塞症的治疗；然而，其药代动力学和药效学特征与维生素 K 拮抗剂完全不同。本研究旨在比较 DOAC 或华法林治疗的静脉血栓栓塞患者在抗凝治疗停药期间和之后 D-二聚体水平的结果。
在 527 例接受 DOAC 治疗的患者（“病例”）（T0）和停药后 15 天（T15）、30 天（T30）、60 天（T60）和 90 天（T90）时测量 D-二聚体水平，以及在 527 例接受 DULCIS 研究（均接受华法林治疗）的患者（“对照”）中测量 D-二聚体水平，病例和对照均为无诱因或伴有弱危险因素的首次静脉血栓栓塞事件后接受抗凝治疗。
病例组在 T0（10.8%对 5.1%，p=0.002）和 T30（18.8%对 11.8%，p=0.019）时以及其他时间点的阳性 D-二聚体结果发生率明显高于对照组，但差异无统计学意义。
在静脉血栓栓塞事件中停止抗凝治疗期间和之后，DOAC 治疗的患者与华法林治疗的患者的 D-二聚体水平不同。需要进行专门的前瞻性研究，重新评估 DOAC 治疗患者 D-二聚体作为预测静脉血栓栓塞复发风险的作用。
