Usefulness of D-dimer testing in predicting recurrence in elderly patients with unprovoked venous thromboembolism.

Tritschler, Tobias; Limacher, Andreas; Méan, Marie; Rodondi, Nicolas; Aujesky, Drahomir (2017). Usefulness of D-dimer testing in predicting recurrence in elderly patients with unprovoked venous thromboembolism. American journal of medicine, 130(10), pp. 1221-1224. Elsevier 10.1016/j.amjmed.2017.04.018

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BACKGROUND Whether post-anticoagulation D-dimer levels are useful in predicting recurrence in elderly patients with unprovoked venous thromboembolism is unknown. METHODS We followed-up 157 patients aged ≥65 years with acute symptomatic unprovoked venous thromboembolism in a prospective multicenter cohort study. All patients completed 3-12 months of anticoagulation and then underwent quantitative D-dimer testing (ELISA, VIDAS DD) 12 months after the index venous thromboembolism. The outcome was recurrent symptomatic venous thromboembolism after D-dimer measurement. We examined associations between log-transformed and dichotomized D-dimer values and the time to venous thromboembolism recurrence using competing risk regression, adjusting for age, sex and overt pulmonary embolism. RESULTS There was no statistically significant association between quantitative or dichotomized D-dimer levels and venous thromboembolism recurrence. The area under the receiver operating characteristic curve for predicting recurrent venous thromboembolism was moderate (0.66, 95% confidence interval [CI] 0.51-0.82). The negative likelihood ratios were 0.34 (95% CI 0.05-2.38) at the usual and 0.34 (95% CI 0.09-1.29) at the age-adjusted cutoff values. Among patients with normal D-dimer results, venous thromboembolism recurrence rates were 6.8 (95% CI 2.2-21.2) per 100 patient-years using the usual and 7.1 (95% CI 3.2-15.8) per 100 patient-years using the age-adjusted cutoff values. CONCLUSION D-dimer testing alone may not be useful in identifying elderly patients with unprovoked venous thromboembolism who are at low risk of recurrent venous thromboembolism and in whom anticoagulants may be safely stopped.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of General Internal Medicine (DAIM) > Clinic of General Internal Medicine > Centre of Competence for General Internal Medicine
04 Faculty of Medicine > Medical Education > Institute of General Practice and Primary Care (BIHAM)
04 Faculty of Medicine > Pre-clinic Human Medicine > Institute of Social and Preventive Medicine
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Tritschler, Tobias; Limacher, Andreas; Méan, Marie; Rodondi, Nicolas and Aujesky, Drahomir

Subjects:

600 Technology > 610 Medicine & health
300 Social sciences, sociology & anthropology > 360 Social problems & social services

ISSN:

0002-9343

Publisher:

Elsevier

Language:

English

Submitter:

Doris Kopp Heim

Date Deposited:

23 May 2017 15:44

Last Modified:

16 May 2018 02:30

Publisher DOI:

10.1016/j.amjmed.2017.04.018

PubMed ID:

28522384

Uncontrolled Keywords:

D-dimer Elderly Recurrence Text word count including abstract Venous thromboembolism and acknowledgements references text

BORIS DOI:

10.7892/boris.100932

URI:

https://boris.unibe.ch/id/eprint/100932

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