D-dimer testing to determine the duration of anticoagulation therapy.
Details
Serval ID
serval:BIB_0503E6044046
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
D-dimer testing to determine the duration of anticoagulation therapy.
Journal
New England Journal of Medicine
Working group(s)
PROLONG Investigators
Contributor(s)
Palareti G., Cosmi B., Legnani C., Brusi C., Testa S., Alatri A., Ghirarduzzi A., Iorio A., Tosetto A., Pengo V., Pegoraro C., Iliceto S., Siragusa S., Prisco D., Poli D., Baudo F., Cappelli R., Erba N., La Rosa L., Pattacini C., Quintavalla R., Ria L., Bucherini E., Ceré E., Rossi V., Tiraferri E., Agazzi C., Coffetti N., Villani C., Frigerio L., Scapoli G., Trifiletti A., Molinatti M., Faccini PD., Santi R., Scannapieco G., Lessiani G., Scarmozzino V., Imbimbo V., Schenone A., Palareti G., Cosmi B., Legnani C., Tosetto A., Tripodi A., Iorio A., Testa S., Ghiraduzzi A., Pattacini C., Pengo V.
ISSN
1533-4406 (Electronic)
ISSN-L
0028-4793
Publication state
Published
Issued date
2006
Peer-reviewed
Oui
Volume
355
Number
17
Pages
1780-1789
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Randomized Controlled Trial ; Research Support, Non-U.S. Gov't
Abstract
BACKGROUND: The optimal duration of oral anticoagulation in patients with idiopathic venous thromboembolism is uncertain. Testing of D-dimer levels may play a role in the assessment of the need for prolonged anticoagulation.
METHODS: We performed D-dimer testing 1 month after the discontinuation of anticoagulation in patients with a first unprovoked proximal deep-vein thrombosis or pulmonary embolism who had received a vitamin K antagonist for at least 3 months. Patients with a normal D-dimer level did not resume anticoagulation, whereas those with an abnormal D-dimer level were randomly assigned either to resume or to discontinue treatment. The study outcome was the composite of recurrent venous thromboembolism and major bleeding during an average follow-up of 1.4 years.
RESULTS: The D-dimer assay was abnormal in 223 of 608 patients (36.7%). A total of 18 events occurred among the 120 patients who stopped anticoagulation (15.0%), as compared with 3 events among the 103 patients who resumed anticoagulation (2.9%), for an adjusted hazard ratio of 4.26 (95% confidence interval [CI], 1.23 to 14.6; P=0.02). Thromboembolism recurred in 24 of 385 patients with a normal D-dimer level (6.2%). Among patients who stopped anticoagulation, the adjusted hazard ratio for recurrent thromboembolism among those with an abnormal D-dimer level, as compared with those with a normal D-dimer level, was 2.27 (95% CI, 1.15 to 4.46; P=0.02).
CONCLUSIONS: Patients with an abnormal D-dimer level 1 month after the discontinuation of anticoagulation have a significant incidence of recurrent venous thromboembolism, which is reduced by the resumption of anticoagulation. The optimal course of anticoagulation in patients with a normal D-dimer level has not been clearly established. (ClinicalTrials.gov number, NCT00264277 [ClinicalTrials.gov].).
METHODS: We performed D-dimer testing 1 month after the discontinuation of anticoagulation in patients with a first unprovoked proximal deep-vein thrombosis or pulmonary embolism who had received a vitamin K antagonist for at least 3 months. Patients with a normal D-dimer level did not resume anticoagulation, whereas those with an abnormal D-dimer level were randomly assigned either to resume or to discontinue treatment. The study outcome was the composite of recurrent venous thromboembolism and major bleeding during an average follow-up of 1.4 years.
RESULTS: The D-dimer assay was abnormal in 223 of 608 patients (36.7%). A total of 18 events occurred among the 120 patients who stopped anticoagulation (15.0%), as compared with 3 events among the 103 patients who resumed anticoagulation (2.9%), for an adjusted hazard ratio of 4.26 (95% confidence interval [CI], 1.23 to 14.6; P=0.02). Thromboembolism recurred in 24 of 385 patients with a normal D-dimer level (6.2%). Among patients who stopped anticoagulation, the adjusted hazard ratio for recurrent thromboembolism among those with an abnormal D-dimer level, as compared with those with a normal D-dimer level, was 2.27 (95% CI, 1.15 to 4.46; P=0.02).
CONCLUSIONS: Patients with an abnormal D-dimer level 1 month after the discontinuation of anticoagulation have a significant incidence of recurrent venous thromboembolism, which is reduced by the resumption of anticoagulation. The optimal course of anticoagulation in patients with a normal D-dimer level has not been clearly established. (ClinicalTrials.gov number, NCT00264277 [ClinicalTrials.gov].).
Keywords
Acenocoumarol/administration & dosage, Adult, Aged, Aged, 80 and over, Anticoagulants/administration & dosage, Antiphospholipid Syndrome/diagnosis, Antithrombins/deficiency, Drug Administration Schedule, Fibrin Fibrinogen Degradation Products/analysis, Follow-Up Studies, Hemorrhage/chemically induced, Humans, Middle Aged, Proportional Hazards Models, Prospective Studies, Pulmonary Embolism/blood, Pulmonary Embolism/diagnosis, Recurrence, Survival Analysis, Venous Thrombosis/blood, Venous Thrombosis/drug therapy, Vitamin K/antagonists & inhibitors, Warfarin/administration & dosage
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Create date
14/02/2013 13:29
Last modification date
03/06/2020 5:26
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