D-dimer testing to determine the duration of anticoagulation therapy

Gualtiero Palareti, Benilde Cosmi, Cristina Legnani, Alberto Tosetto, Carlotta Brusi, Alfonso Iorio, Vittorio Pengo, Angelo Ghirarduzzi, Corrado Pattacini, Sophie Testa, Anthonie W A Lensing, Armando Tripodi

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)1780-1789
Number of pages10
JournalNew England Journal of Medicine
Volume355
Issue number17
DOIs
Publication statusPublished - Oct 26 2006

ASJC Scopus subject areas

  • Medicine(all)

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    Palareti, G., Cosmi, B., Legnani, C., Tosetto, A., Brusi, C., Iorio, A., Pengo, V., Ghirarduzzi, A., Pattacini, C., Testa, S., Lensing, A. W. A., & Tripodi, A. (2006). D-dimer testing to determine the duration of anticoagulation therapy. New England Journal of Medicine, 355(17), 1780-1789. https://doi.org/10.1056/NEJMoa054444