Migita Shohei, Okumura Yasuo, Fukuda Ikuo, Nakamura Mashio, Yamada Norikazu, Takayama Morimasa, Maeda Hideaki, Yamashita Takeshi, Ikeda Takanori, Mo Makoto, Yamazaki Tsutomu, Hirayama Atsushi
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Department of Cardiology, Keimeikai Yokawa Hospital, Miki, Japan.
Front Cardiovasc Med. 2023 Feb 9;10:1074661. doi: 10.3389/fcvm.2023.1074661. eCollection 2023.
D-dimer is a biomarker of fibrin production and degradation, and changes in D-dimer concentration suggest fibrin clot formation, which is associated with thromboembolism and hypercoagulable states. Thus, an elevated D-dimer concentration could be a useful prognostic predictor for patients with venous thromboembolism (VTE).
In this subanalysis of the J'xactly study, a prospective multicenter study conducted in Japan, we examined the clinical outcomes of 949 patients with VTE stratified by baseline D-dimer concentration. The median D-dimer concentration was 7.6 μg/ml (low D-dimer group: <7.6 μg/ml [ = 473, 49.8%]; high D-dimer group: ≥7.6 μg/ml [ = 476, 50.2%]). The mean age of the patients was 68 years, and 386 patients (40.7%) were male. Compared with the low D-dimer group, the high D-dimer group had more frequent pulmonary embolism with or without deep vein thrombosis (DVT), proximal DVT, atrial fibrillation, or diabetes mellitus, and underwent intensive treatment with 30 mg/day rivaroxaban. The incidence of composite clinically relevant events (recurrence or exacerbation of symptomatic VTE, acute coronary syndrome [ACS], ischemic stroke, death from any cause, or major bleeding) was higher in the high D-dimer group than in the low D-dimer group (11.1% vs. 7.5% per patient-year; hazard ratio, 1.46; 95% confidence interval, 1.05-2.04; = 0.025). There was no significant difference between the high and low D-dimer groups in the incidence of VTE (2.8% vs. 2.5% per patient-year, respectively; = 0.788), ACS (0.4% per patient-year vs. not observed, respectively; = 0.078), or major bleeding (4.0% vs. 2.1% per patient-year, respectively; = 0.087), but there was a significant difference in the incidence of ischemic stroke (1.0% per patient-year vs. not observed, respectively; = 0.004).
Elevated D-dimer concentration may be an important prognostic predictor in Japanese patients with VTE.: UMIN CTR, UMIN000025072 (https://www.umin.ac.jp/ctr/index.htm).
D - 二聚体是纤维蛋白生成和降解的生物标志物，D - 二聚体浓度的变化提示纤维蛋白凝块形成，这与血栓栓塞和高凝状态相关。因此，D - 二聚体浓度升高可能是静脉血栓栓塞症（VTE）患者有用的预后预测指标。
在这项对日本进行的前瞻性多中心研究J'xactly研究的亚组分析中，我们检查了949例VTE患者按基线D - 二聚体浓度分层后的临床结局。D - 二聚体浓度中位数为7.6μg/ml（低D - 二聚体组：<7.6μg/ml [= 473例，49.8%]；高D - 二聚体组：≥7.6μg/ml [= 476例，50.2%]）。患者的平均年龄为68岁，386例患者（40.7%）为男性。与低D - 二聚体组相比，高D - 二聚体组发生伴有或不伴有深静脉血栓形成（DVT）的肺栓塞、近端DVT、心房颤动或糖尿病的情况更频繁，并且接受了30mg/天利伐沙班的强化治疗。高D - 二聚体组复合临床相关事件（有症状VTE的复发或加重、急性冠状动脉综合征[ACS]、缺血性卒中、任何原因导致的死亡或大出血）的发生率高于低D - 二聚体组（每位患者每年11.1% vs. 7.5%；风险比，1.46；95%置信区间，1.05 - 2.04；P = 0.025）。高D - 二聚体组和低D - 二聚体组在VTE发生率（分别为每位患者每年2.8% vs. 2.5%；P = 0.788）、ACS发生率（分别为每位患者每年0.4% vs. 未观察到；P = 0.078）或大出血发生率（分别为每位患者每年4.0% vs. 2.1%；P = 0.087）方面无显著差异，但在缺血性卒中发生率方面存在显著差异（分别为每位患者每年1.0% vs. 未观察到；P = 0.004）。
D - 二聚体浓度升高可能是日本VTE患者重要的预后预测指标。：UMIN CTR，UMIN000025072（https://www.umin.ac.jp/ctr/index.htm）
