Utility of Plasma D-dimer in Decision to Continue Anticoagulation Therapy Following Idiopathic Venous Thromboembolism

Abstract

Evidence-Based Answer A single normal D-dimer at the time of the standard oral anticoagulation therapy (OAT) treatment period of 3-6 months is insufficient to predict recurrence of venous thromboembolism (VTE) because OAT may suppress D-dimer levels even in individuals at risk for recurrence (Strength of Recommendation (SOR) B). A negative D-dimer one month after discontinuation of OAT has a high negative predictive value for recurrent VTE, and supports the decision to permanently discontinue treatment (SOR A). Elevated D-dimer levels, either at the end of the recommended course of OAT or upon repeat in one month if the initial level is normal, predict recurrence of VTE and support the decision to resume OAT (SOR A).