scholarly journals D-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study

Blood ◽  
2014 ◽  
Vol 124 (2) ◽  
pp. 196-203 ◽  
Author(s):  
Gualtiero Palareti ◽  
Benilde Cosmi ◽  
Cristina Legnani ◽  
Emilia Antonucci ◽  
Valeria De Micheli ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Standard Therapy ◽  
Recurrence Risk ◽  
Management Study ◽  
Key Points ◽  
Risk Patients ◽  
D Dimer

Key Points The duration of anticoagulation after VTE is uncertain; this management study intended to identify patients with low/high recurrence risk. Patients with persistently negative D-dimers after stopping standard therapy have a low recurrence risk and can stop anticoagulation.

scholarly journals Predictors of venous thromboembolism recurrence and bleeding among active cancer patients: a population-based cohort study

Blood ◽  
2014 ◽  
Vol 123 (25) ◽  
pp. 3972-3978 ◽  
Author(s):  
Cheng E. Chee ◽  
Aneel A. Ashrani ◽  
Randolph S. Marks ◽  
Tanya M. Petterson ◽  
Kent R. Bailey ◽  
...  
Keyword(s):  
Cohort Study ◽  
Venous Thromboembolism ◽  
Recurrence Risk ◽  
Population Based ◽  
Secondary Prophylaxis ◽  
Cancer Type ◽  
Patients With Cancer ◽  
Key Points ◽  
Venous Thromboembolism Recurrence ◽  
Active Cancer

Key Points VTE recurrence risk in patients with cancer can be stratified by cancer type, stage, stage progression, and presence of leg paresis. Patients with cancer at high VTE recurrence risk should be considered for secondary prophylaxis.

Increased Neutrophil Adhesive Properties In Patients with Venous Thromboembolism and Residual Vein Thrombosis and High D-Dimer Levels

Blood ◽  
2011 ◽  
Vol 118 (21) ◽  
pp. 2301-2301
Author(s):  
kiara Cristina Senger Zapponi ◽  
Luis Fernando Bittar ◽  
Bruna m Mazetto ◽  
Fernanda Dutra Santiago-Bassora ◽  
Fernanda A. Orsi ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Venous Thrombosis ◽  
Recurrence Risk ◽  
Neutrophil Adhesion ◽  
Baseline Characteristic ◽  
Adherent Cells ◽  
Adhesive Properties ◽  
Vein Thrombosis ◽  
Significant Difference ◽  
D Dimer

Abstract Abstract 2301 Introduction: Venous Thromboembolism (VTE) is a multifactorial disease that affects 1:1000 individuals worldwide, with a recurrence rate of about 25% in 10 years. Although many risk factors for VTE are well defined, first presentation and recurrence depend, at least in part, on as yet unknown etiologic factors. Studies in animal models show a tight relation between inflammation and hemostasis, as well as the infiltration of neutrophils in the venous wall after the induction of venous thrombosis. Neutrophils also participate in different stages in the formation and resolution of venous thrombosis. Methods: In this study, we investigated the adhesive properties of neutrophils in VTE patients. We hypothesized that increased adhesive properties of these cells, either as an individual baseline characteristic or as an acquired alteration after a previous VTE episode, could be associated with the thrombotic process. The patient population consisted of 22 VTE patients (14F:8M; median age: 46.1 years) that had completed at least 6 months of oral anticoagulation. Twenty-two healthy volunteers matched to VTE patients by age, gender and ethnic background were used as controls. Neutrophil adhesion was measured by a static adhesion assay in triplicate. Peripheral blood was collected with heparin and neutrophils were separated on Histopaque® (Sigma-Aldrich, St. Louis, MO, USA). Isolated neutrophils (2.2×106 cells/ml) were allowed to adhere to fibronectin (FN)-coated 96-well plates (30 min, 37°C, 5%CO2). Non-adherent cells were then removed by washing and adherent cells calculated as the percentage of cells adhered, compared to a standard curve of known cell concentrations and using a colorimetric enzyme assay. Results are expressed as means ± standard error of mean (SEM) and were compared using the Mann-Whitney test. Results: Overall, adhesion of neutrophils from VTE patients (25.40% ±2.35) was not increased when compared to the control group (21.25%±1.20 p=0.2). However when only patients at a higher risk of recurrence (n=13) - here defined as the presence of elevated D-dimer (higher than 0.5mg/L) and residual vein thrombosis - were analyzed, a statistically significant increase in cell adhesion compared to matched controls was observed (26.70%±2.08 and 21.36%±1.26, respectively, p = 0.04). When these patients (higher recurrence risk; n=13) were compared to the remaining VTE patients (standard recurrence risk, n=9), a non significant increase in neutrophil adhesion was observed (26.70%±2.08 vs 23.51%±5.03 respectively, p=0.1). Conclusions: We demonstrate that neutrophil adhesion is increased in patients with VTE with characteristics associated with increased recurrence risk. In addition, we also observed a non-significant difference in neutrophil adhesion in these patients compared to other VTE patients. Our results suggest that the increased adhesive properties of neutrophils in VTE patients could play a role in the exacerbation of inflammation, and in the pathophysiology of VTE. Further studies are warranted to study whether neutrophil adhesiveness could be used as a biomarker of VTE recurrence. Disclosures: No relevant conflicts of interest to declare.

scholarly journals D-Dimer Levels and Risk of Recurrence Following Provoked Venous Thromboembolism: Findings from the Riete Registry

Blood ◽  
2018 ◽  
Vol 132 (Supplement 1) ◽  
pp. 3810-3810
Author(s):  
Martin Ellis ◽  
Martin Mar ◽  
Monreal Manuel ◽  
Orly Hamburger-Avnery ◽  
Alessandra Bura-Riviere ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
Venous Thromboembolism ◽  
Anticoagulant Therapy ◽  
Conflicts Of Interest ◽  
Hazard Ratio ◽  
Increased Risk ◽  
Risk Patients ◽  
Recurrent Vte ◽  
D Dimer

Abstract Background. Patients with venous thromboembolism (VTE) secondary to transient risk factors or cancer may develop VTE recurrences after discontinuing anticoagulant therapy. Identifying at-risk patients could help to guide the ideal duration of anticoagulant therapy in these patients. 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. The proportion of patients with raised d-dimer levels was determined and the hazard ratio (HR) for VTE recurrences compared to those with normal levels was calculated. Univariate and multivariate analyses of factors associated with VTE recurrence were performed. Results. 3 606 patients were identified in the database in April 2018: 2 590 had VTE after a transient risk factor and 1016 had a cancer. D-dimer levels were measured after discontinuing anticoagulation in 1 732 (67%) patients with transient risk factors and 732 (72%) patients with cancer-associated VTE and these patients formed the cohort in which recurrent VTE rate was calculated. D-dimers and were elevated in 551 (31.8%) of patients with a transient risk factor and were normal in 1181 (68.2%). In the cancer-associated group, d-dimers were elevated in 398 (54.3%) and normal in 334 (45.7%) patients. The adjusted hazard ratio for recurrent VTE was: 2.32 (95%CI: 1.55-3.49) in patients with transient risk factors and 2.23 (95%CI: 1.50-3.39) in those with cancer. Conclusions. Patients with raised d-dimer levels after discontinuing anticoagulant therapy for provoked or cancer-associated VTE are at increased risk for recurrent VTE and death. Future studies could target these patients for extended anticoagulation. Disclosures No relevant conflicts of interest to declare.

Comorbidities, alone and in combination with D-dimer, as risk factors for recurrence after a first episode of unprovoked venous thromboembolism in the extended follow-up of the PROLONG study

2010 ◽  
Vol 103 (06) ◽  
pp. 1152-1160 ◽  
Author(s):  
Cristina Legnani ◽  
Alberto Tosetto ◽  
Vittorio Pengo ◽  
Angelo Ghirarduzzi ◽  
Sophie Testa ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Patient Characteristics ◽  
Recurrence Risk ◽  
Randomised Clinical Trial ◽  
Chronic Inflammatory Bowel Disease ◽  
First Episode ◽  
Chronic Obstructive ◽  
Risk Of Recurrence ◽  
D Dimer

SummaryThe PROLONG randomised clinical trial showed that an abnormal D-dimer at one month after vitamin K antagonist (VKA) suspension for a first episode of unprovoked venous thromboembolism (VTE) is associated with a higher risk of recurrence. However, other patient characteristics, such as comorbidities, in combination with D-dimer could also influence the recurrence risk. It was the objective of this study to assess the predictive value of comorbidities and D-dimer in combination for recurrence after withdrawal of VKA in patients enrolled in the PROLONG study. On the day of VKA suspension, the presence of known (coronary, peripheral,cerebral) vascular disease, chronic inflammatory bowel disease, chronic obstructive pulmonary disease, autoimmune disease, diabetes, arterial hypertension, obesity and dyslipidaemias was registered. D-dimer was measured at 30 ± 10 days afterwards. The primary outcome was recurrent objectively documented VTE. Mean follow-up was 2.55 years. An abnormal D-dimer was observed in 44% (135/309) of patients with comorbidities and in 29% (87/299) of patients without (p=0.0003). An on-treatment analysis was conducted in 483 patients in whom VKAs were not resumed. In patients with a normal D-dimer, recurrences were observed in 14.3% (24/168) of patients with comorbidities and 10.8% (22/203) of subjects without (p=ns). In patients with an abnormal D-dimer, recurrences were observed in 24.6% (16/65) patients with comorbidities and 21.3% (10/47) of patients without (p=ns). Although abnormal D-dimer levels were significantly more frequent in patients with comorbidities, D-dimer was an independent risk factor for recurrence and the presence of comorbidities did not increase the risk of recurrence associated with an abnormal post-anticoagulation D-dimer.ClinicalTrials.gov number: NCT00264277

scholarly journals Antiphospholipid antibodies and recurrent thrombosis after a first unprovoked venous thromboembolism

Blood ◽  
2018 ◽  
Vol 131 (19) ◽  
pp. 2151-2160 ◽  
Author(s):  
Clive Kearon ◽  
Sameer Parpia ◽  
Frederick A. Spencer ◽  
Trevor Baglin ◽  
Scott M. Stevens ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Antiphospholipid Antibodies ◽  
Recurrent Thrombosis ◽  
Key Points ◽  
Recurrent Vte ◽  
D Dimer

Key Points The same type of APA on 2 occasions or >1 type of APA on the same or different occasions is associated with recurrent VTE. APA and D-dimer levels seem to be independently associated with recurrence after a first unprovoked VTE.

scholarly journals Venous Thromboembolism in Patients Discharged after COVID-19 Hospitalization

2021 ◽  
Author(s):  
Matthias M. Engelen ◽  
Christophe Vandenbriele ◽  
Tim Balthazar ◽  
Eveline Claeys ◽  
Jan Gunst ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Deep Vein Thrombosis ◽  
Venous Thromboembolism ◽  
C Reactive Protein ◽  
Systematic Screening ◽  
Vein Thrombosis ◽  
Reactive Protein ◽  
Risk Patients ◽  
Deep Vein ◽  
D Dimer

Abstract Background Venous thromboembolism (VTE) is a frequent complication of COVID-19, so that the importance of adequate in-hospital thromboprophylaxis in patients hospitalized with COVID-19 is well established. However, the incidence of VTE after discharge and whether postdischarge thromboprophylaxis is beneficial and safe are unclear. In this prospective observational single-center study, we report the incidence of VTE 6 weeks after hospitalization and the use of postdischarge thromboprophylaxis. Methods Patients hospitalized with confirmed COVID-19 were invited to a multidisciplinary follow-up clinic 6 weeks after discharge. D-dimer and C-reactive protein were measured, and all patients were screened for deep vein thrombosis with venous duplex-ultrasound. Additionally, selected high-risk patients received computed tomography pulmonary angiogram or ventilation–perfusion (V/Q) scan to screen for incidental pulmonary embolism. Results Of 485 consecutive patients hospitalized from March through June 2020, 146 patients were analyzed, of which 39% had been admitted to the intensive care unit (ICU). Postdischarge thromboprophylaxis was prescribed in 28% of patients, but was used more frequently after ICU stay (61%) and in patients with higher maximal D-dimer and C-reactive protein levels during hospitalization. Six weeks after discharge, elevated D-dimer values were present in 32% of ward and 42% of ICU patients. Only one asymptomatic deep vein thrombosis (0.7%) and one symptomatic pulmonary embolism (0.7%) were diagnosed with systematic screening. No bleedings were reported. Conclusion In patients who had been hospitalized with COVID-19, systematic screening for VTE 6 weeks after discharge revealed a low incidence of VTE. A strategy of selectively providing postdischarge thromboprophylaxis in high-risk patients seems safe and potentially effective.

scholarly journals Risk factors predictive of occult cancer detection in patients with unprovoked venous thromboembolism

Blood ◽  
2016 ◽  
Vol 127 (16) ◽  
pp. 2035-2037 ◽  
Author(s):  
Ryma Ihaddadene ◽  
Daniel J. Corsi ◽  
Alejandro Lazo-Langner ◽  
Sudeep Shivakumar ◽  
Ryan Zarychanski ◽  
...  
Keyword(s):  
Risk Factors ◽  
Venous Thromboembolism ◽  
High Risk ◽  
Cancer Detection ◽  
Smoking Status ◽  
Screening Strategy ◽  
High Risk Patients ◽  
Occult Cancer ◽  
Key Points ◽  
Risk Patients

Key Points It remains unclear whether a subgroup of high-risk patients could potentially benefit from a more extensive screening strategy. Age, prior provoked VTE, and smoking status may be important predictors of occult cancer detection in patients with first unprovoked VTE.

scholarly journals Increased D-Dimer Levels and Residual Venous Thrombosis Are Associated with Late Recurrence of Deep Venous Thrombosis

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 3554-3554
Author(s):  
Bruna Moraes Mazetto ◽  
Fernanda Andrade Orsi ◽  
Mariane Flores-Nascimento ◽  
Sandra Silveira ◽  
Luis Fernando Bittar ◽  
...  
Keyword(s):  
Risk Factors ◽  
Relative Risk ◽  
Venous Thrombosis ◽  
Conflicts Of Interest ◽  
Recurrence Risk ◽  
Late Recurrence ◽  
Long Time ◽  
Risk Patients ◽  
D Dimer

Abstract Background: Many patients present new thrombotic events even long-time after the first thrombotic episode and risk factors for recurrence in these cases are not fully elucidated. Aim: To evaluate the risk of late recurrence of thrombosis after a first DVT episode. Methods: This is a prospective observational study. We evaluated the association of D-dimer (DD) levels and persistent residual venous thrombosis (RVT), by Doppler ultrasound, with the occurrence of new thrombotic events long-time after the acute DVT episode. Results: Fifty-six patients were enrolled for the study. For all patients, DVT episode occurred more than 12 months apart from the enrollment day. Median follow-up was 28 months. During the follow-up time, 10 patients presented thrombosis recurrence. Patients who suffered DVT recurrence had higher DD levels than those who did not had recurrence (median= 0.99 vs 0.40, respectively). The best cut-off value to discriminate those at risk for recurrence was DD > 0.63mg/L (area= 0.7380 95%CI= 0.5800 to 0.8961, P=0.01). Recurrence occurred in 27.7% of patients with previous DD>0.63mg/L and in 5.9% of patients with previous DD< 0.63mg/L (relative risk = 6.46; 95%CI 1.36- 30.52, P=0.007). New thrombosis events occurred only in patients with previously documented RVT, mainly in patients with hypoechoic RVT. During follow-up, new thrombotic events were diagnosed in 75% of patients with hypoechoic RVT. The relative risk for recurrence according to the presence of RVT was 9.129 (95% CI= 2.60-32.02, P<0.001). The presence of RVT also modified the effect of DD on the recurrence risk. Patients with DD > 0,63mg/L but without RVT had similar risk of recurrence than those with DD< 0.63mg/L, whereas the risk for recurrence increased in 14-15 times in patients with RVT. Conclusion: These results suggests that the persistence of residual thrombosis combined with high levels of DD, long-time after the acute DVT, are risk factors associated with late thrombosis recurrence. Disclosures No relevant conflicts of interest to declare.

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