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

Publicado en:Journal Of Internal Medicine. 287 (1): 32-41 - 2020-01-01 287(1), DOI: 10.1111/joim.12969

Autores: Avnery O; Martin M; Bura-Riviere A; Barillari G; Mazzolai L; Mahé I; Marchena PJ; Verhamme P; Monreal M; Ellis MH; Adarraga MD; Aibar MA; Aibar J; Amado C; Arcelus JI; Ballaz A; Barba R; Barrón M; Barrón-Andrés B; Bascuñana J; ina A; Camon AM; Cañas I; Carrasco C; Castro J; de Ancos C; del Toro J; Demelo P; Díaz-Peromingo JA; Falgá C; Farfán AI; Fernández-Capitán C; Fernández-Criado MC; Fernández-Núñez S; Fidalgo MA; Font C; Font L; Freire M; Gallego M; García MA; García-Bragado F; García-Morillo M; García-Raso A; Gavín O; Gayol MC; Gil-Díaz A; Gómez V; Gómez-Cuervo C; González-Martínez J; Grau E; Gutiérrez J; Hernández-Blasco LM; Iglesias M; Jara-Palomares L; Jaras MJ; Jiménez R; Jiménez-Castro D; Jiménez-López J; Joya MD; Lima J; Llamas P; Lobo JL; López-Jiménez L; López-Miguel P; López-Núñez JJ; López-Reyes R; López-Sáez JB; Lorente MA; Lorenzo A; Loring M; Madridano O; Maestre A; Martín del Pozo M; Martín-Guerra JM; Martín-Romero M; Mellado M; Morales MV; Muñoz N; Nieto-Cabrera MA; Nieto-Rodríguez JA; Núñez-Ares A; Núñez MJ; Olivares MC; Otalora S; Otero R; Pedrajas JM; Pellejero G; Pérez-Rus G; Peris ML; Porras JA; Rivas A; Rodríguez-Dávila MA; Rodríguez-Hernández A; Rubio CM; Ruiz-Artacho P; Ruiz-Ruiz J; Ruiz-Torregrosa P; Ruiz-Sada P; Sahuquillo JC; Salazar V

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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.

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