David A. Garcia, MD
In patients with unprovoked venous thromboembolism (VTE), do D-dimer levels predict risk for recurrent symptomatic VTE after anticoagulant therapy is stopped?
Studies selected measured D-dimer levels at 3 weeks to 2 months after stopping anticoagulant therapy in patients with a first unprovoked VTE who received therapy for ≥ 3 months. Outcome was recurrent symptomatic VTE.
Medline, EMBASE/Excerpta Medica, CINAHL, Cochrane Central Register of Controlled Trials, and reference lists (all to Mar 2008) were searched, and experts were contacted for prospective cohort studies or randomized controlled trials (RCTs). 5 prospective cohort studies and 2 RCTs (n = 1888) met the selection criteria. 4 studies enrolled consecutive patients; all studies used independent outcome assessment blinded to D-dimer results and had ≥ 1 year follow-up; 2 studies had < 2% loss to follow-up (other studies did not report follow-up).
After anticoagulant therapy was stopped, 48% of patients had positive D-dimer levels and 52% of patients had negative D-dimer levels. Patients with positive D-dimer levels had greater risk for recurrent VTE than did patients with negative D-dimer levels (Table).
In patients with a first unprovoked venous thromboembolism, D-dimer levels predict risk for recurrent symptomatic venous thromboembolism after anticoagulant therapy is stopped.
Annualized risk and likelihood ratios (LRs) for recurrent venous thromboembolism (VTE) based on D-dimer levels after anticoagulant therapy*
*LR and CI defined in Glossary. LR calculated from data in article. Analysis based on a random-effects model.
†Cutoff levels were 500 µg/L in 6 studies and 250 µg/L in 1 study.
Garcia DA. Review: D-dimer levels predict risk for recurrent VTE after anticoagulant therapy is stopped. Ann Intern Med. ;150:JC2–14. doi: 10.7326/0003-4819-150-4-200902170-02014
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Published: Ann Intern Med. 2009;150(4):JC2-14.
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