This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on ISI (80)  • Contact me when this article is cited  Related Content  • Related letter  • Similar articles in JAMA  Topic Collections  • Venous Thromboembolism  • Alert me on articles by topic

Sabine Eichinger, MD; Erich Minar, MD; Christine Bialonczyk, MD; Mirko Hirschl, MD; Peter Quehenberger, MD; Barbara Schneider, PhD; Ansgar Weltermann, MD; Oswald Wagner, MD; Paul A. Kyrle, MD

JAMA. 2003;290:1071-1074.

Context  Widespread screening of patients with venous thromboembolism (VTE) for thrombophilic risk factors has become common clinical practice. Because of the increasing number of risk factors, assessing the risk of recurrence in an individual patient is intricate; therefore, a laboratory method that measures multifactorial thrombophilia is required.

Objective  To prospectively study the relationship between the risk of recurrent VTE and D-dimer, a global marker of coagulation activation and fibrinolysis.

Design, Setting, and Participants  Prospective cohort study of 610 patients older than 18 years who were treated with oral anticoagulants for at least 3 months with a first spontaneous VTE, in whom D-dimer levels were measured shortly after discontinuation of oral anticoagulation. The study was conducted at the Department of Internal Medicine I, University Hospital, Vienna, Austria. Patients entered the study at time of discontinuation of oral anticoagulants and were observed at 3-month intervals during the first year and every 6 months thereafter from July 1992 to October 2002.

Main Outcome Measure  Objectively documented symptomatic recurrent VTE.

Results  A total of 79 (13%) of 610 patients had recurrent VTE with a mean observation time of 38 months. Patients with recurrence had significantly higher D-dimer levels compared with those without recurrence (553 ng/mL vs 427 ng/mL, P = .01). Compared with patients with D-dimer levels of 750 ng/mL or higher, the relative risk (RR) of recurrence was 0.6 (95% confidence interval [CI], 0.3-1.4), 0.6 (95% CI, 0.3-1.2), and 0.3 (95% CI, 0.1-0.6) in patients with D-dimer levels of 500 to 749 ng/mL, 250 to 499 ng/mL, and less than 250 ng/mL, respectively. The cumulative probability of recurrent VTE at 2 years was 3.7% (95% CI, 0.9%-6.5%) among patients with D-dimer levels of less than 250 ng/mL compared with 11.5% (95% CI, 8.0%-15.0%) among patients with higher levels (P = .001). Patients with D-dimer levels of less than 250 ng/mL had a 60% lower RR of recurrence compared with patients with higher levels (RR, 0.4; 95% CI, 0.2-0.8).

Conclusion  Patients with a first spontaneous VTE and a D-dimer level of less than 250 ng/mL after withdrawal of oral anticoagulation have a low risk of VTE recurrence.

Author Affiliations: Department of Internal Medicine I (Drs Eichinger, Weltermann, and Kyrle), Ludwig-Boltzmann Institute (Dr Kyrle), Department of Internal Medicine II (Dr Minar), Clinical Institute of Medical and Chemical Laboratory Diagnostics (Drs Quehenberger and Wagner), and Institute of Medical Statistics (Dr Schneider), University of Vienna, Austria; and Wilhelminenspital (Dr Bialonczyk) and Hanuschkrankenhaus (Dr Hirschl), Vienna, Austria.

RELATED LETTER

Identifying Patients at Risk of Recurrent Venous Thromboembolism
Daniel J. Brotman
JAMA. 2003;290(24):3192.
EXTRACT | FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Systematic Review: D-Dimer to Predict Recurrent Disease after Stopping Anticoagulant Therapy for Unprovoked Venous Thromboembolism
Verhovsek et al.
ANN INTERN MED 2008;149:481-490.
ABSTRACT | FULL TEXT  

Identifying unprovoked thromboembolism patients at low risk for recurrence who can discontinue anticoagulant therapy
Rodger et al.
CMAJ 2008;179:417-426.
ABSTRACT | FULL TEXT  

Different cut-off values of quantitative D-dimer methods to predict the risk of venous thromboembolism recurrence: a post-hoc analysis of the PROLONG study
Legnani et al.
haematol 2008;93:900-907.
ABSTRACT | FULL TEXT  

Antithrombotic Therapy for Venous Thromboembolic Disease: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition)
Kearon et al.
Chest 2008;133:454S-545S.
ABSTRACT | FULL TEXT  

Venous thrombosis in the elderly: more questions than answers
Silverstein et al.
Blood 2007;110:3097-3101.
FULL TEXT  

A thrombolytic regimen for high-risk deep venous thrombosis may substantially reduce the risk of postthrombotic syndrome in children
Goldenberg et al.
Blood 2007;110:45-53.
ABSTRACT | FULL TEXT  

D-Dimer and Duration of Anticoagulation
Pernod et al.
NEJM 2007;356:421-423.
FULL TEXT  

D-Dimer Testing to Determine the Duration of Anticoagulation Therapy
Palareti et al.
NEJM 2006;355:1780-1789.
ABSTRACT | FULL TEXT  

Homozygosity in the Single Nucleotide Polymorphism Ser128Arg in the E-Selectin Gene Associated With Recurrent Venous Thromboembolism.
Jilma et al.
Arch Intern Med 2006;166:1655-1659.
ABSTRACT | FULL TEXT  

Dementia Severity of the Care Receiver Predicts Procoagulant Response in Alzheimer Caregivers
Aschbacher et al.
AJGP 2006;14:694-703.
ABSTRACT | FULL TEXT  

Management of venous thromboembolism: [Traitement de la maladie thromboembolique veineuse].
de Moerloose et al.
Canadian J. Anesthesia 2006;53:S80-S88.
ABSTRACT | FULL TEXT  

How I treat venous thrombosis in children
Manco-Johnson
Blood 2006;107:21-29.
FULL TEXT  

High clotting factor activities and enhanced platelet-related haemostasis in a patient with recurrent episodes of thrombotic-thrombocytopenic purpura: additional risk factors for onset and recurrence?
Sucker et al.
Nephrol Dial Transplant 2005;20:1515-1516.
FULL TEXT  

Inherited Risk Factors for Venous Thrombosis
Cushman
ASH Education Book 2005;2005:452-457.
ABSTRACT | FULL TEXT  

Venous Thrombosis in Children
Righini et al.
NEJM 2004;351:2451-2452.
FULL TEXT  

Anticoagulation Monitoring
Smythe and Caffee
Journal of Pharmacy Practice 2004;17:317-326.
ABSTRACT  

Elevated Plasma Factor VIII and D-Dimer Levels as Predictors of Poor Outcomes of Thrombosis in Children
Goldenberg et al.
NEJM 2004;351:1081-1088.
ABSTRACT | FULL TEXT  

Antithrombotic Therapy for Venous Thromboembolic Disease: The Seventh ACCP Conference on Antithrombotic and Thrombolytic Therapy
Buller et al.
Chest 2004;126:401S-428S.
ABSTRACT | FULL TEXT  

Long-Term Management of Patients After Venous Thromboembolism
Kearon
Circulation 2004;110:I-10-I-18.
ABSTRACT | FULL TEXT  

Mars or Venus -- Is Sex a Risk Factor for Recurrent Venous Thromboembolism?
Elliott and Rubin
NEJM 2004;350:2614-2616.
FULL TEXT  

Thrombin-activatable fibrinolysis inhibitor and the risk for recurrent venous thromboembolism
Eichinger et al.
Blood 2004;103:3773-3776.
ABSTRACT | FULL TEXT  

Additional articles abstracted in ACP Journal Club
Evid. Based Med. 2004;9:35-35.
FULL TEXT  

Thrombophilia and New Anticoagulant Drugs
Weitz et al.
ASH Education Book 2004;2004:424-438.
ABSTRACT | FULL TEXT  

Deep Venous Thrombosis
Lopez et al.
ASH Education Book 2004;2004:439-456.
ABSTRACT | FULL TEXT  

Identifying Patients at Risk of Recurrent Venous Thromboembolism
Brotman
JAMA 2003;290:3192-3192.
FULL TEXT  

Can D-dimer Levels Predict Recurrent VTE?
Journal Watch Cardiology 2003;2003:5-5.
FULL TEXT  

Can D-dimer Levels Help to Predict VTE Recurrence?
JWatch General 2003;2003:1-1.
FULL TEXT