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D-dimer levels and risk of recurrence following provoked venous thromboembolism: findings from the RIETE registry.

Abstract：

BACKGROUND:Patients with venous thromboembolism (VTE) secondary to transient risk factors may develop VTE recurrences after discontinuing anticoagulation. Identifying at-risk patients could help to guide the duration of therapy. METHODS:We used the RIETE database to assess the prognostic value of d-dimer testing after discontinuing anticoagulation to identify patients at increased risk for recurrences. Transient risk factors were classified as major (postoperative) or minor (pregnancy, oestrogen use, immobilization or recent travel). RESULTS:In December 2018, 1655 VTE patients with transient risk factors (major 460, minor 1195) underwent d-dimer measurements after discontinuing anticoagulation. Amongst patients with major risk factors, the recurrence rate was 5.74 (95% CI: 3.19-9.57) events per 100 patient-years in those with raised d-dimer levels and 2.68 (95% CI: 1.45-4.56) in those with normal levels. Amongst patients with minor risk factors, the rates were 7.79 (95% CI: 5.71-10.4) and 3.34 (95% CI: 2.39-4.53), respectively. Patients with major risk factors and raised d-dimer levels (n = 171) had a nonsignificantly higher rate of recurrences (hazard ratio [HR]: 2.14; 95% CI: 0.96-4.79) than those with normal levels. Patients with minor risk factors and raised d-dimer levels (n = 382) had a higher rate of recurrences (HR: 2.34; 95% CI: 1.51-3.63) than those with normal levels. On multivariate analysis, raised d-dimers (HR: 1.74; 95% CI: 1.09-2.77) were associated with an increased risk for recurrences in patients with minor risk factors, not in those with major risk factors. CONCLUSIONS:Patients with raised d-dimer levels after discontinuing anticoagulant therapy for VTE provoked by a minor transient risk factor were at an increased risk for recurrences.

journal_name

J Intern Med

journal_title

Journal of internal medicine

authors

Avnery O,Martin M,Bura-Riviere A,Barillari G,Mazzolai L,Mahé I,Marchena PJ,Verhamme P,Monreal M,Ellis MH,RIETE Investigators.

doi

10.1111/joim.12969

subject

Has Abstract

pub_date

2020-01-01 00:00:00

pages

32-41

issue

eissn

0954-6820

issn

1365-2796

journal_volume

287

pub_type

杂志文章

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D-dimer levels and risk of recurrence following provoked venous thromboembolism: findings from the RIETE registry.