D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with non-Vitamin K anticoagulants

Cristina Legnani, Ida Martinelli, Gualtiero Palareti, Alessandro Ciavarella, Daniela Poli, Walter Ageno, Sophie Testa, Daniela Mastroiacovo, Maurizio Ciammaichella, Eugenio Bucherini, Nicola Mumoli, Benilde Cosmi

Research output: Contribution to journalArticle

Abstract

Background D-dimer levels measured during and after vitamin K antagonist withdrawal may be used in clinical practice to assess the individual risk of recurrent venous thromboembolism. Currently, direct oral anticoagulants (DOACs) are frequently used in venous thromboembolism treatment; however, their pharmacokinetics and pharmacodynamics characteristics are completely different than vitamin K antagonists. The present study aimed at comparing the results of D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with DOACs or warfarin. Material and methods D-dimer levels were measured in 527 patients (“cases”) during DOACs treatment (T0) and after 15 (T15), 30 (T30), 60 (T60) and 90 (T90) days after their discontinuation and in 527 patients (“controls”) enrolled in the DULCIS study (all treated with warfarin), matched for sex, age (+/-3 y), type of D-dimer assay and site of venous thromboembolism. Both cases and controls received anticoagulant treatment after a first venous thromboembolism event that was unprovoked or associated with weak risk factors. Results The rate of positive D-dimer results was significantly higher in cases than in controls at T0 (10.8% vs 5.1%, p = 0.002) and at T30 (18.8% vs 11.8%, p = 0.019), as well as at the other time-points, though not statistically significant. Conclusion D-dimer levels during and after stopping an anticoagulant treatment for a venous thromboembolism episode differ between patients treated with a DOAC than in those treated with warfarin. Specifically designed prospective studies are warranted to reassess the use of D-dimer as predictor of the risk of recurrent venous thromboembolism in patients treated with DOACs.

Original languageEnglish
Article numbere0219751
JournalPLoS One
Volume14
Issue number7
DOIs
Publication statusPublished - Jan 1 2019

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anticoagulants
Venous Thromboembolism
Anticoagulants
mouth
warfarin
Warfarin
vitamin K
Vitamin K
antagonists
Pharmacodynamics
Pharmacokinetics
pharmacology
Therapeutics
fibrin fragment D
prospective studies
pharmacokinetics
Assays
risk factors
Prospective Studies
gender

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)

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D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with non-Vitamin K anticoagulants. / Legnani, Cristina; Martinelli, Ida; Palareti, Gualtiero; Ciavarella, Alessandro; Poli, Daniela; Ageno, Walter; Testa, Sophie; Mastroiacovo, Daniela; Ciammaichella, Maurizio; Bucherini, Eugenio; Mumoli, Nicola; Cosmi, Benilde.

In: PLoS One, Vol. 14, No. 7, e0219751, 01.01.2019.

Research output: Contribution to journalArticle

Legnani, C, Martinelli, I, Palareti, G, Ciavarella, A, Poli, D, Ageno, W, Testa, S, Mastroiacovo, D, Ciammaichella, M, Bucherini, E, Mumoli, N & Cosmi, B 2019, 'D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with non-Vitamin K anticoagulants', PLoS One, vol. 14, no. 7, e0219751. https://doi.org/10.1371/journal.pone.0219751
Legnani, Cristina ; Martinelli, Ida ; Palareti, Gualtiero ; Ciavarella, Alessandro ; Poli, Daniela ; Ageno, Walter ; Testa, Sophie ; Mastroiacovo, Daniela ; Ciammaichella, Maurizio ; Bucherini, Eugenio ; Mumoli, Nicola ; Cosmi, Benilde. / D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with non-Vitamin K anticoagulants. In: PLoS One. 2019 ; Vol. 14, No. 7.
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abstract = "Background D-dimer levels measured during and after vitamin K antagonist withdrawal may be used in clinical practice to assess the individual risk of recurrent venous thromboembolism. Currently, direct oral anticoagulants (DOACs) are frequently used in venous thromboembolism treatment; however, their pharmacokinetics and pharmacodynamics characteristics are completely different than vitamin K antagonists. The present study aimed at comparing the results of D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with DOACs or warfarin. Material and methods D-dimer levels were measured in 527 patients (“cases”) during DOACs treatment (T0) and after 15 (T15), 30 (T30), 60 (T60) and 90 (T90) days after their discontinuation and in 527 patients (“controls”) enrolled in the DULCIS study (all treated with warfarin), matched for sex, age (+/-3 y), type of D-dimer assay and site of venous thromboembolism. Both cases and controls received anticoagulant treatment after a first venous thromboembolism event that was unprovoked or associated with weak risk factors. Results The rate of positive D-dimer results was significantly higher in cases than in controls at T0 (10.8{\%} vs 5.1{\%}, p = 0.002) and at T30 (18.8{\%} vs 11.8{\%}, p = 0.019), as well as at the other time-points, though not statistically significant. Conclusion D-dimer levels during and after stopping an anticoagulant treatment for a venous thromboembolism episode differ between patients treated with a DOAC than in those treated with warfarin. Specifically designed prospective studies are warranted to reassess the use of D-dimer as predictor of the risk of recurrent venous thromboembolism in patients treated with DOACs.",
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T1 - D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with non-Vitamin K anticoagulants

AU - Legnani, Cristina

AU - Martinelli, Ida

AU - Palareti, Gualtiero

AU - Ciavarella, Alessandro

AU - Poli, Daniela

AU - Ageno, Walter

AU - Testa, Sophie

AU - Mastroiacovo, Daniela

AU - Ciammaichella, Maurizio

AU - Bucherini, Eugenio

AU - Mumoli, Nicola

AU - Cosmi, Benilde

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Y1 - 2019/1/1

N2 - Background D-dimer levels measured during and after vitamin K antagonist withdrawal may be used in clinical practice to assess the individual risk of recurrent venous thromboembolism. Currently, direct oral anticoagulants (DOACs) are frequently used in venous thromboembolism treatment; however, their pharmacokinetics and pharmacodynamics characteristics are completely different than vitamin K antagonists. The present study aimed at comparing the results of D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with DOACs or warfarin. Material and methods D-dimer levels were measured in 527 patients (“cases”) during DOACs treatment (T0) and after 15 (T15), 30 (T30), 60 (T60) and 90 (T90) days after their discontinuation and in 527 patients (“controls”) enrolled in the DULCIS study (all treated with warfarin), matched for sex, age (+/-3 y), type of D-dimer assay and site of venous thromboembolism. Both cases and controls received anticoagulant treatment after a first venous thromboembolism event that was unprovoked or associated with weak risk factors. Results The rate of positive D-dimer results was significantly higher in cases than in controls at T0 (10.8% vs 5.1%, p = 0.002) and at T30 (18.8% vs 11.8%, p = 0.019), as well as at the other time-points, though not statistically significant. Conclusion D-dimer levels during and after stopping an anticoagulant treatment for a venous thromboembolism episode differ between patients treated with a DOAC than in those treated with warfarin. Specifically designed prospective studies are warranted to reassess the use of D-dimer as predictor of the risk of recurrent venous thromboembolism in patients treated with DOACs.

AB - Background D-dimer levels measured during and after vitamin K antagonist withdrawal may be used in clinical practice to assess the individual risk of recurrent venous thromboembolism. Currently, direct oral anticoagulants (DOACs) are frequently used in venous thromboembolism treatment; however, their pharmacokinetics and pharmacodynamics characteristics are completely different than vitamin K antagonists. The present study aimed at comparing the results of D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with DOACs or warfarin. Material and methods D-dimer levels were measured in 527 patients (“cases”) during DOACs treatment (T0) and after 15 (T15), 30 (T30), 60 (T60) and 90 (T90) days after their discontinuation and in 527 patients (“controls”) enrolled in the DULCIS study (all treated with warfarin), matched for sex, age (+/-3 y), type of D-dimer assay and site of venous thromboembolism. Both cases and controls received anticoagulant treatment after a first venous thromboembolism event that was unprovoked or associated with weak risk factors. Results The rate of positive D-dimer results was significantly higher in cases than in controls at T0 (10.8% vs 5.1%, p = 0.002) and at T30 (18.8% vs 11.8%, p = 0.019), as well as at the other time-points, though not statistically significant. Conclusion D-dimer levels during and after stopping an anticoagulant treatment for a venous thromboembolism episode differ between patients treated with a DOAC than in those treated with warfarin. Specifically designed prospective studies are warranted to reassess the use of D-dimer as predictor of the risk of recurrent venous thromboembolism in patients treated with DOACs.

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