Department of Translational Medical Sciences, Federico II University, Naples, Italy.
Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy.
Eur J Intern Med. 2021 Jul;89:39-47. doi: 10.1016/j.ejim.2021.04.004. Epub 2021 Apr 29.
Venous thromboembolism (VTE) recurrence is a major concern after a first symptomatic episode, potentially impacting survival and healthcare needs in community, hospital and rehabilitation settings. We evaluated the association of D-Dimer positivity after oral anticoagulant therapy (OAT) discontinuation with VTE recurrence.
PubMed, Web of Science, Scopus and EMBASE databases were systematically searched. Differences were expressed as Odds Ratio (OR) with 95% confidence intervals (95%CI). Pooled sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), and summary ROC (sROC) curve were calculated.
Twenty-six articles on 10,725 VTE patients showed that the absolute risk of recurrence was 16.1% (95%CI: 13.2%-19.5%) among 4,049 patients with a positive D-Dimer and 7.4% (95%CI: 6.0%-9.0%) in 6,676 controls (OR: 2.1, 95%CI: 1.7-2.8, P<0.001), with an attributable risk of 54.0%. sROC curve of the association between positive D-Dimer and recurrence showed a diagnostic AUC of 63.8 (95%CI: 60.3-67.4), with a pooled sensitivity of 54.3% (95%CI: 51.3%-57.3%), specificity of 64.2% (95%CI: 63.2-65.1), PLR of 1.53 (95%CI: 1.37-1.72), and NLR of 0.71 (95%CI: 0.60-0.84). Subgroup and meta-regression analyses suggested that a positive D-Dimer may have a higher discriminatory ability for patients with provoked events, confirmed by better pooled diagnostic indexes for recurrence and a diagnostic AUC of 70.6 (95%CI: 63.8-77.4). Regression models showed that the rate of OAT resumption after the evidence of D-Dimer positivity was inversely associated with VTE recurrence (Z-score: -3.91, P<0.001).
D-Dimer positivity after OAT may identify VTE patients at higher risk of recurrence, with a better diagnostic accuracy for provoked events.
静脉血栓栓塞症（VTE）复发是首次有症状发作后的一个主要关注点，可能会影响社区、医院和康复环境中的生存和医疗需求。我们评估了口服抗凝治疗（OAT）停药后 D-二聚体阳性与 VTE 复发的关系。
系统检索了 PubMed、Web of Science、Scopus 和 EMBASE 数据库。差异用优势比（OR）及其 95%置信区间（95%CI）表示。计算了汇总敏感性、特异性、阳性似然比（PLR）和阴性似然比（NLR）以及汇总受试者工作特征（sROC）曲线。
在纳入的 10725 例 VTE 患者的 26 项研究中，4049 例 D-二聚体阳性患者中有 16.1%（95%CI：13.2%-19.5%）出现绝对复发风险，6676 例对照组中有 7.4%（95%CI：6.0%-9.0%）（OR：2.1，95%CI：1.7-2.8，P<0.001），归因风险为 54.0%。D-二聚体阳性与复发之间关联的 sROC 曲线显示出 63.8%（95%CI：60.3-67.4）的诊断 AUC，汇总敏感性为 54.3%（95%CI：51.3%-57.3%），特异性为 64.2%（95%CI：63.2-65.1%），阳性似然比为 1.53（95%CI：1.37-1.72），阴性似然比为 0.71（95%CI：0.60-0.84）。亚组和荟萃回归分析表明，对于有明确诱因的患者，D-二聚体可能具有更高的鉴别能力，这可以从对复发的汇总诊断指标和 70.6%（95%CI：63.8-77.4）的诊断 AUC 得到证实。回归模型表明，在 D-二聚体阳性后恢复 OAT 的比率与 VTE 复发呈负相关（Z 分数：-3.91，P<0.001）。
OAT 后 D-二聚体阳性可能提示 VTE 患者复发风险较高，对有明确诱因的患者具有更好的诊断准确性。
