Comorbidities, alone and in combination with D-dimer, as risk factors for recurrence after a first episode of unprovoked venous thrombo-embolism in the extended follow-up of the PROLONG study

Benilde Cosmi, Cristina Legnani, Alberto Tosetto, Vittorio Pengo, Angelo Ghirarduzzi, Sophie Testa, Domenico Prisco, Daniela Poli, Armando Tripodi, Gualtiero Palareti

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

The PROLONG randomised clinical trial showed that an abnormal D-dimer at one month after vitamin K antagonist (VKA) suspension for a first episode of unprovoked venous thromboembolism (VTE) is associated with a higher risk of recurrence. However, other patient characteristics, such as comorbidities, in combination with D-dimer could also influence the recurrence risk. It was the objective of this study to assess the predictive value of comorbidities and D-dimer in combination for recurrence after withdrawal of VKA in patients enrolled in the PROLONG study. On the day of VKA suspension, the presence of known (coronary, peripheral,cerebral) vascular disease, chronic inflammatory bowel disease, chronic obstructive pulmonary disease, autoimmune disease, diabetes, arterial hypertension, obesity and dyslipidaemias was registered. D-dimer was measured at 30 ± 10 days afterwards. The primary outcome was recurrent objectively documented VTE. Mean follow-up was 2.55 years. An abnormal D-dimer was observed in 44% (135/309) of patients with comorbidities and in 29% (87/299) of patients without (p=0.0003). An on-treatment analysis was conducted in 483 patients in whom VKAs were not resumed. In patients with a normal D-dimer, recurrences were observed in 14.3% (24/168) of patients with comorbidities and 10.8% (22/203) of subjects without (p=ns). In patients with an abnormal D-dimer, recurrences were observed in 24.6% (16/65) patients with comorbidities and 21.3% (10/47) of patients without (p=ns). Although abnormal D-dimer levels were significantly more frequent in patients with comorbidities, D-dimer was an independent risk factor for recurrence and the presence of comorbidities did not increase the risk of recurrence associated with an abnormal post-anticoagulation D-dimer.

Original languageEnglish
Pages (from-to)1152-1160
Number of pages9
JournalThrombosis and Haemostasis
Volume103
Issue number6
DOIs
Publication statusPublished - 2010

Fingerprint

Embolism
Comorbidity
Recurrence
Vitamin K
Venous Thromboembolism
Suspensions
fibrin fragment D
Peripheral Vascular Diseases
Dyslipidemias
Type 1 Diabetes Mellitus
Inflammatory Bowel Diseases
Chronic Obstructive Pulmonary Disease
Autoimmune Diseases
Randomized Controlled Trials
Obesity
Hypertension

Keywords

  • Atherosclerosis
  • Hypercoagulability
  • Oral anti-coagulants
  • Risk factors
  • Venous thromboembolism

ASJC Scopus subject areas

  • Hematology
  • Medicine(all)

Cite this

Comorbidities, alone and in combination with D-dimer, as risk factors for recurrence after a first episode of unprovoked venous thrombo-embolism in the extended follow-up of the PROLONG study. / Cosmi, Benilde; Legnani, Cristina; Tosetto, Alberto; Pengo, Vittorio; Ghirarduzzi, Angelo; Testa, Sophie; Prisco, Domenico; Poli, Daniela; Tripodi, Armando; Palareti, Gualtiero.

In: Thrombosis and Haemostasis, Vol. 103, No. 6, 2010, p. 1152-1160.

Research output: Contribution to journalArticle

Cosmi, Benilde ; Legnani, Cristina ; Tosetto, Alberto ; Pengo, Vittorio ; Ghirarduzzi, Angelo ; Testa, Sophie ; Prisco, Domenico ; Poli, Daniela ; Tripodi, Armando ; Palareti, Gualtiero. / Comorbidities, alone and in combination with D-dimer, as risk factors for recurrence after a first episode of unprovoked venous thrombo-embolism in the extended follow-up of the PROLONG study. In: Thrombosis and Haemostasis. 2010 ; Vol. 103, No. 6. pp. 1152-1160.
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abstract = "The PROLONG randomised clinical trial showed that an abnormal D-dimer at one month after vitamin K antagonist (VKA) suspension for a first episode of unprovoked venous thromboembolism (VTE) is associated with a higher risk of recurrence. However, other patient characteristics, such as comorbidities, in combination with D-dimer could also influence the recurrence risk. It was the objective of this study to assess the predictive value of comorbidities and D-dimer in combination for recurrence after withdrawal of VKA in patients enrolled in the PROLONG study. On the day of VKA suspension, the presence of known (coronary, peripheral,cerebral) vascular disease, chronic inflammatory bowel disease, chronic obstructive pulmonary disease, autoimmune disease, diabetes, arterial hypertension, obesity and dyslipidaemias was registered. D-dimer was measured at 30 ± 10 days afterwards. The primary outcome was recurrent objectively documented VTE. Mean follow-up was 2.55 years. An abnormal D-dimer was observed in 44{\%} (135/309) of patients with comorbidities and in 29{\%} (87/299) of patients without (p=0.0003). An on-treatment analysis was conducted in 483 patients in whom VKAs were not resumed. In patients with a normal D-dimer, recurrences were observed in 14.3{\%} (24/168) of patients with comorbidities and 10.8{\%} (22/203) of subjects without (p=ns). In patients with an abnormal D-dimer, recurrences were observed in 24.6{\%} (16/65) patients with comorbidities and 21.3{\%} (10/47) of patients without (p=ns). Although abnormal D-dimer levels were significantly more frequent in patients with comorbidities, D-dimer was an independent risk factor for recurrence and the presence of comorbidities did not increase the risk of recurrence associated with an abnormal post-anticoagulation D-dimer.",
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AU - Legnani, Cristina

AU - Tosetto, Alberto

AU - Pengo, Vittorio

AU - Ghirarduzzi, Angelo

AU - Testa, Sophie

AU - Prisco, Domenico

AU - Poli, Daniela

AU - Tripodi, Armando

AU - Palareti, Gualtiero

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