Can a single blood test decide the duration of treatment for patients with venous thrombosis?
Venous thrombosis patients with persistently negative D-dimer tests after cessation of standard therapy have a low recurrence risk and can stop anticoagulation. A study conducted by Italian scientists show that a management procedure based on repeated D-dimer testing can be used to identify those with a low risk of recurrence in whom anticoagulation can be discontinued.
The optimal duration of anticoagulation after venous thrombosis is uncertain. Anticoagulant therapy efficiently lowers the risk of recurrent thrombosis, but is associated with increased risk of bleeding.
This management study intended to assess whether a management procedure involving serial D-dimer testing and residual vein thrombosis assessment could identify a subset of subjects at low risk of recurrence in whom anticoagulation could be safely discontinued.
In the study 1010 outpatients with a first episode of proximal deep vein thrombosis of the lower limbs and/or pulmonary embolism and who had received a standard course of anticoagulation, or at least 12 months in case of residual vein thrombosis, was analysed.
D-dimer was measured just before discontinuation of anticoagulant treatment, and then repeated at 15, 30, 60 and 90 days after discontinuation. Patients were invited to prolong or resume anticoagulation as soon as the D-dimer test result was positive.
Half of the patients had persistently negative D-dimer and stopped anticoagulation. The recurrence rate among these patients was low. Further, 40% of the patients had positive D-dimer and resumed anticoagulation, while the remaining 10% refused to resume anticoagulation despite their positive D-dimer. Thus, in patients with positive D-dimer who refused anticoagulation the recurrence rate was about threefold higher than in patients with persistently negative D-dimer.
The study indicates that serial D-dimer can be useful in clinical practice for the identification of venous thrombosis patients in whom anticoagulation can be safely discontinued.
The article is published in Blood
Palareti G, Cosmi B, Legnani C, Antonucci E, De Micheli V, Ghirarduzzi A, et al. D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study. Blood. 2014; 124(2): 196-203.
Last updated: 18.09.2014 09:49