Sex, age and normal post-anticoagulation D-dimer as risk factors for recurrence after idiopathic venous thromboembolism in the Prolong study extension

B. Cosmi, C. Legnani, A. Tosetto, V. Pengo, A. Ghirarduzzi, S. Testa, D. Prisco, D. Poli, A. Tripodi, G. Palareti

Research output: Contribution to journalArticlepeer-review

Abstract

Background: The PROLONG randomized study showed that patients with an abnormal D-dimer after anticoagulation suspension for a first unprovoked episode of venous thromboembolism (VTE) benefited from anticoagulation resumption. Patients with normal D-dimer after anticoagulation suspension had a low recurrence rate (4.4% patient-years) but their anticoagulation optimal duration remained uncertain. Objectives: To assess whether sex and age, in combination with normal D-dimer, are risk factors for VTE recurrence in patients enrolled in the PROLONG study extended follow-up. Methods: D-dimer was measured at 1 month after anticoagulation suspension. Patients with a normal D-dimer did not resume anticoagulants, whereas patients with an abnormal D-dimer were randomized either to resume or not anticoagulants. Primary outcome was recurrent VTE. Results: After excluding patients resuming anticoagulants for abnormal D-dimer, recurrences were higher in males than females [7.4% patient-years - 47/639 vs 4.3% patient-years - 27/626; hazard ratio (HR) = 1.7; P = 0.027] and in patients aged 65 or older than in younger patients (8.4% patient-years - 50/598 vs 3.6% patient-years - 24/667; HR = 2.1; P = 0.003). In patients with normal D-dimer and younger than 65, recurrences were higher in males than in females (5.1% vs. 0.4% patient-years; adjusted HR = 10.6; P = 0.023) and both females and males aged 65 years or older had more recurrences (6.6% and 8.1% patient-years, respectively, adjusted HR: 16.0; P = 0.008 and 16.0; P = 0.008, respectively) than females younger than 65. Conclusions: In patients with idiopathic VTE and a normal D-dimer at 1 month after anticoagulation suspension, females younger than 65 had a very low risk of recurrence.

Original languageEnglish
Pages (from-to)1933-1942
Number of pages10
JournalJournal of Thrombosis and Haemostasis
Volume8
Issue number9
DOIs
Publication statusPublished - Sep 2010

Keywords

  • D-dimer
  • Hypercoagulability
  • Recurrence
  • Risk factors
  • Venous thromboembolism
  • Vitamin K antagonists

ASJC Scopus subject areas

  • Hematology

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