The new role of D-dimer as a predictor of recurrent venous thromboembolism D-Dimere: Ihre neue Rolle als Prädiktoren für rezidivierende venöse Thromboembolien

Abstract

Abstract Venous thromboembolism (VTE) tends to recur after oral anticoagulant therapy (OAT) withdrawal, regardless of the duration of treatment. As a result, the optimal duration of OAT after VTE is still a matter of debate. Patients are currently stratified in risk categories for recurrence on the basis of the clinical characteristics of the index event. Distal deep vein thrombosis (DVT) or VTE due to a transient risk factor are associated with a low risk of recurrence and a brief three-month course of anticoagulation is usually recommended. An event which is either idiopathic or with known thrombophilic defects, such as FV Leiden or the G20120A prothrombin mutation, is associated with a high risk of recurrence and an OAT course of at least six months is recommended. More recently, D-dimer (D-d) levels have been shown to be additional risk factors for recurrence. D-d has been evaluated both during OAT and after its withdrawal. In some patients, after VTE D-d levels are persistently elevated during anticoagulation in spite of apparently adequate antithrombotic treatment, which could indicate insufficient anticoagulation. D-d is more frequently altered during anticoagulation in patients with idiopathic or cancer-associated VTE than with secondary VTE. After idiopathic DVT, the time spent at near normal International Normalized Ratio (INR) values (<1.5) during the first three months of OAT is associated with higher D-d values measured during OAT and after its interruption and is a significant risk factor for late VTE recurrences. Moreover, altered D-d significantly increases the risk of recurrence associated with inherited thrombophilic conditions, while residual venous obstruction does not increase the risk of recurrence associated with abnormal D-d. Results of a management study (PROLONG study) indicate that subjects with negative D-d at one month after OAT withdrawal have a low risk of recurrence, while those with altered D-d have a significantly higher risk and deserve prolonged OAT treatment.