School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Department of Medicine, University of Ottawa and The Ottawa Hospital, Ottawa, Canada.
O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.
Thromb Res. 2023 Nov;231:32-38. doi: 10.1016/j.thromres.2023.09.012. Epub 2023 Sep 26.
While several risk stratification tools have been developed to predict the risk of recurrence in patients with an unprovoked venous thromboembolism (VTE), only 1 in 4 patients are categorized as low-risk. Rather than a one-time measure, serial D-dimer assessment holds promise to enhance the prediction of VTE recurrence after oral anticoagulant (OAC) cessation.
Using the REVERSE cohort, we compared VTE recurrence among patients with normal D-dimer levels (<490 ng/mL among males under age 70, <500 ng/mL in others) at OAC cessation and 1-month follow-up, to those with an elevated D-dimer level at either timepoint. We also evaluated VTE recurrence based on absolute increase in D-dimer levels between the two timepoints (e.g., ∆D-dimer) according to quartiles.
Among 214 patients with serial D-dimer levels measured at OAC cessation and 1-month follow-up, an elevated D-dimer level at either timepoint was associated with a numerically higher risk of recurrent VTE than patients with normal D-dimer levels at both timepoints (6.9 % vs. 4.2 % per year, hazard ratio 1.6; 95 % CI 0.9-2.7). Among women with <2 HERDOO2 criteria, a normal D-dimer level at both timepoints predicted a very low risk of recurrent VTE during follow-up (0.8 % per year, 95 % CI 0.1-2.8). Irrespective of baseline value, recurrent VTE risk was only 3 % per year (95 % CI 1.4-5.6) among patients in the lowest ∆D-dimer quartile.
Serial normal D-dimer levels have the potential to identify patients at a low risk of recurrent VTE. In addition, ∆D-dimer, irrespective of its elevation above cutoff threshold, may predict recurrent VTE.
尽管已经开发了几种风险分层工具来预测无诱因静脉血栓栓塞症 (VTE) 患者的复发风险，但只有 1/4 的患者被归类为低风险。连续 D-二聚体评估不仅仅是一种一次性的衡量标准，它有望增强口服抗凝剂 (OAC) 停药后 VTE 复发的预测。
我们使用 REVERSE 队列，比较了在 OAC 停药和 1 个月随访时 D-二聚体水平正常（<70 岁男性<490ng/mL，其他人群<500ng/mL）的患者与在任何时间点 D-二聚体水平升高的患者之间的 VTE 复发情况。我们还根据两个时间点之间 D-二聚体水平的绝对升高（例如，∆D-二聚体）评估了 VTE 复发情况，根据四分位数进行评估。
在 214 例接受 OAC 停药和 1 个月随访时进行了连续 D-二聚体水平测量的患者中，与两个时间点 D-二聚体水平均正常的患者相比，任何一个时间点 D-二聚体水平升高的患者 VTE 复发的风险更高（6.9%比 4.2%/年，风险比 1.6；95%CI 0.9-2.7）。在<2 个 HERDOO2 标准的女性中，两个时间点的 D-二聚体水平正常预测随访期间 VTE 复发的风险极低（0.8%/年，95%CI 0.1-2.8）。无论基线值如何，在 ∆D-二聚体最低四分位数的患者中，VTE 复发风险仅为每年 3%（95%CI 1.4-5.6）。
连续正常的 D-二聚体水平有可能识别出 VTE 复发风险较低的患者。此外，∆D-二聚体，无论其升高是否超过截断阈值，都可能预测 VTE 复发。
