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Persistently negative D-dimers associated with low VTE recurrence
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Patients with persistently negative D-dimer measurements demonstrated a low risk for venous thromboembolism recurrence and were able to safety discontinue anticoagulation, according to study results.
The analysis included 1,010 outpatients who had been receiving anticoagulation therapy for at least 3 months after a first venous thromboembolism (VTE) that was unprovoked or associated with weak risk factors, such as minor surgery or trauma, pregnancy or contraceptive use. Researchers measured each patient’s D-dimer levels using age- and sex-specific cut-off values for up to 2 years.
More than half of the population (n=528; 52.3%) had persistently negative D-dimer levels and stopped anticoagulation.
Twenty-five patients with negative D-dimer levels experienced a composite endpoint event — VTE recurrence or death due to VTE — equating to a 3% (95% CI, 2-4.4) incidence rate per 100 persons-year. More patients with negative D-dimer levels who experienced an event were aged older than 70 years (8.9% vs. 2.1%; P=.0008).
The remaining 482 patients (47.7%) with positive D-dimer levels were significantly older than patients with normal levels (P˂.0001), more likely to have had an idiopathic index event than an event associated with weak risk factors (51.1% vs. 36.8%; P˂.0001), and were less likely to be a young female (P˂.01). Of these patients, 373 resumed anticoagulation, whereas 109 refused it.
Fifteen of the patients who refused anticoagulation experienced an event (8.8% incidence per 100 persons-year), whereas four patients who continued anticoagulation experienced an event (0.7% per 100 persons-year; HR=2.92; 95% CI, 1.87-9.72).
Fourteen patients who resumed anticoagulation experienced major hemorrhages (2.3% per 100 persons-year; 95% CI, 1.3-3.9), one of which was fatal.
“Our study showed that, based on persistently normal D-dimer tests, anticoagulation could be stopped in more than 50% of patients included after a single idiopathic or associated with weak risk factors VTE event,” the researchers wrote. “The recurrence rate during follow-up was as low as 3% persons-year … which is below rates recommended as acceptable to justify anticoagulation discontinuation.”
Disclosure: The researchers report no relevant financial disclosures.
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