D-dimer levels and risk of recurrence following provoked venous thromboembolism: findings from the RIETE registry
Por:
Avnery, O, Martin, M, Ellis, MH, Adarraga, MD, Aibar, MA, Aibar, J, Amado, C, Arcelus, JI, Ballaz, A, Barba, R, Barron, M, Barron-Andres, B, Bascunana, J, Blanco-Molina, A, Camon, AM, Canas, I, Carrasco, C, Castro, J, de Ancos, C, del Toro, J, Demelo, P, Diaz-Peromingo, JA, Falga, C, Farfan, AI, Fernandez-Capitan, C, Fernandez-Criado, MC, Fernandez-Nunez, S, Fidalgo, MA, Font, C, Font, L, Freire, M, Gallego, M, Garcia, MA, Garcia-Bragado, F, Garcia-Morillo, M, Garcia-Raso, A, Gavin, O, Gayol, MC, Gil-Diaz, A, Gomez, V, Gomez-Cuervo, C, Gonzalez-Martinez, J, Grau, E, Gutierrez, J, Hernandez-Blasco, LM, Iglesias, M, Jara-Palomares, L, Jaras, MJ, Jimenez, R, Jimenez-Castro, D, Jimenez-Lopez, J, Joya, MD, Lima, J, Llamas, P, Lobo, JL, Lopez-Jimenez, L, Lopez-Miguel, P, Lopez-Nunez, JJ, Lopez-Reyes, R, Lopez-Saez, JB, Lorente, MA, Lorenzo, A, Loring, M, Madridano, O, Maestre, A, Marchena, PJ, del Pozo, MM, Martin-Guerra, JM, Martin-Romero, M, Mellado, M, Monreal, M, Morales, MV, Munoz, N, Nieto-Cabrera, MA, Nieto-Rodriguez, JA, Nunez-Ares, A, Nunez, MJ, Olivares, MC, Otalora, S, Otero, R, Pedrajas, JM, Pellejero, G, Perez-Rus, G, Peris, ML, Porras, JA, Rivas, A, Rodriguez-Davila, MA, Rodriguez-Hernandez, A, Rubio, CM, Ruiz-Artacho, P, Ruiz-Ruiz, J, Ruiz-Torregrosa, P, Ruiz-Sada, P, Sahuquillo, JC, Salazar, V, Samperiz, A, Sanchez-Munoz-Torrero, JF, Sancho, T, Soler, S, Sopena, B, Surinach, JM, Tolosa, C, Torres, MI, Trujillo-Santos, J, Uresandi, F, Valle, R, Vidal, G, Villares, P, Gutierrez, P, Vazquez, FJ, Vilaseca, A, Vanassche, T, Vandenbriele, C, Verhamme, P, Hirmerova, J, Maly, R, Salgado, E, Benzidia, I, Bertoletti, L, Bura-Riviere, A, Debourdeau, P, Farge-Bancel, D, Hij, A, Mahe, I, Moustafa, F, Schellong, S, Braester, A, Brenner, B, Ellis, M, Tzoran, I, Sharif-Kashani, B, Barillari, G, Bilora, F, Bortoluzzi, C, Bucherini, E, Ciammaichella, M, Dentali, F, Di Micco, P, Di Pangrazio, M, Maida, R, Mastroiacovo, D, Pace, F, Pallotti, G, Parisi, R, Pesavento, R, Prandoni, P, Quintavalla, R, Rocci, A, Siniscalchi, C, Tufano, A, Visona, A, Hong, NV, Gibietis, VL, Skride, A, Strautmane, S, Bosevski, M, Zdraveska, M, Bounameaux, H, Fresa, M, Mazzolai, L, Ney, B, Caprini, J, Bui, HM and Pham, KQ
Publicada:
1 ene 2020
Ahead of Print:
1 ago 2019
Resumen:
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.
Filiaciones:
Avnery, O:
Meir Med Ctr, Hematol Inst & Blood Bank, Kefar Sava, Israel
Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel
Martin, M:
Hosp Infanta Sofia San Sebastian de los Reyes, Madrid, Spain
Univ Europea Madrid, Madrid, Spain
Ellis, MH:
Meir Med Ctr, Hematol Inst & Blood Bank, Kefar Sava, Israel
Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel
Marchena, PJ:
Parc Sanitari St Joan Deu Hosp Gen, Dept Internal Med & Emergency, Barcelona, Spain
:
Hosp Univ Germans Trios & Pujol, Barcelona, Spain
Verhamme, P:
Univ Leuven, Vasc Med & Haemostasis, Leuven, Belgium
Bura-Riviere, A:
Hop Rangueil, Dept Vasc Med, Toulouse, France
Mahe, I:
Univ Paris 07, Hop Louis Mowier, AP HP, Dept Internal Med, Colombes, France
Ellis, M:
Meir Med Ctr, Hematol Inst & Blood Bank, Kefar Sava, Israel
Tel Aviv Univ, Sackler Sch Med, Tel Aviv, Israel
Barillari, G:
Osped S Maria Misericordia, Dept Internal Med, Udine, Italy
Mazzolai, L:
CHU Vaudois, Dept Angiol, Lausanne, Switzerland
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