Authors: BRUINSTROOP, E.; KLOK, F. A.¹; VAN DE REE, M. A.²; OOSTERWIJK, F. L.³; HUISMAN, M. V.¹

Source: Journal of Thrombosis and Haemostasis, Volume 7, Number 4, April 2009 , pp. 611-618(8)

Publisher: Wiley-Blackwell

Abstract:

Summary. 

Background: The evidence on the optimal duration of treatment in patients with an idiopathic venous thromboembolic event (VTE) is inconclusive.d-dimer testing to predict recurrent VTE has been evaluated in several studies. Objectives: We performed a meta-analysis of studies of patients with idiopathic VTE treated with oral anticoagulation therapy (OAT) to assess the prognostic value of elevatedd-dimer levels 1 month after discontinuation of OAT for VTE recurrence. Patients/Methods: The MEDLINE, EMBASE and Cochrane databases were searched to identify relevant studies. Studies were eligible for inclusion if they included patients with idiopathic VTE and in addition reported results for this group separately, had measuredd-dimer approximately 1 month after discontinuation of OAT and had reported on recurrence of VTE. A random-effects model was used to pool study results. Results: Data from four studies (1539 patients) were included in the current analysis. All studies reported on the number of recurrent events in the normal and elevatedd-dimer groups. Overall, 125 of 751 patients (16.6%) with elevatedd-dimer levels experienced recurrent VTE during the period of follow-up compared with 57 of 788 patients (7.2%) with normald-dimer levels. Elevatedd-dimer levels were significantly associated with recurrent VTE (odds ratio , 2.36; 95% CI, 1.65 to 3.36). Conclusions: Elevatedd-dimer levels measured 1 month after discontinuation of OAT identify patients with idiopathic VTE at higher risk of recurrence.

Keywords: fibrin fragment D; prognosis; pulmonary embolism; recurrence; venous thrombosis

Document Type: Research article

DOI: http://dx.doi.org/10.1111/j.1538-7836.2009.03293.x

Affiliations: 1: Leiden University Medical Center, Section of Vascular Medicine, Department of General Internal Medicine-Endocrinology, Leiden 2: Diakonessenhuis, Department of Internal Medicine, Bosboomstraat 1, Utrecht 3: University Medical Center Utrecht, Utrecht, the Netherlands

Publication date: 2009-04-01

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