D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with non-vitamin K anticoagulants

被引:17
作者
Legnani, Cristina [1 ]
Martinelli, Ida [2 ]
Palareti, Gualtiero [1 ]
Ciavarella, Alessandro [2 ]
Poli, Daniela [3 ]
Ageno, Walter [4 ,5 ]
Testa, Sophie [6 ]
Mastroiacovo, Daniela [7 ]
Ciammaichella, Maurizio [8 ]
Bucherini, Eugenio [9 ]
Mumoli, Nicola [10 ]
Cosmi, Benilde [11 ]
机构
[1] Fdn Arianna Anticoagulaz, Bologna, Italy
[2] Osped Maggiore Policlin, A Bianchi Bonomi Hemophilia & Thrombosis Ctr, Fdn Ca Granda, Ist Ricovero & Cura Carattere Sci, Milan, Italy
[3] Azienda Osped Univ Careggi, Malattie Aterotrombot, Florence, Italy
[4] Azienda Socio Sanit Terr Sette Laghi, Degenza Breve Internist & Ctr Trombosi Emostas, Varese, Italy
[5] Azienda Socio Sanit Terr Sette Laghi, Ctr Trombosi Emostasi, Varese, Italy
[6] Azienda Socio Sanit Terr Cremona, Ctr Emostasi & Trombosi, Lab Anal Chim Clin & Microbiol, Cremona, Italy
[7] Osped Civile SS Filippo & Nicola, Unita Operat Semplice, Dipartimentale Angiol & Diagnost Vasc, Laquila, Italy
[8] Azienda Osped S Giovanni Addolorata, Unita Operat Complessa Med Urgenza, Rome, Italy
[9] Osped Civile Faenza, Struttura Semplice Dipartimentale Med Vasc, Faenza, Ravenna, Italy
[10] Osped Fornaroli, Unita Operat Complessa Med Interna, Milan, Italy
[11] Azienda Osped Univ Bologna, Policlin S Orsola Malpighi, Unita Operat Angiol & Malattie Coagulaz, Bologna, Italy
来源
PLOS ONE | 2019年 / 14卷 / 07期
关键词
1ST EPISODE; ORAL ANTICOAGULATION; PULMONARY-EMBOLISM; THERAPY; RECURRENCE; RISK; DURATION;
D O I
10.1371/journal.pone.0219751
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Background D-dimer levels measured during and after vitamin K antagonist withdrawal may be used in clinical practice to assess the individual risk of recurrent venous thromboembolism. Currently, direct oral anticoagulants (DOACs) are frequently used in venous thromboembolism treatment; however, their pharmacokinetics and pharmacodynamics characteristics are completely different than vitamin K antagonists. The present study aimed at comparing the results of D-dimer levels during and after anticoagulation withdrawal in patients with venous thromboembolism treated with DOACs or warfarin. Material and methods D-dimer levels were measured in 527 patients ("cases") during DOACs treatment (T0) and after 15 (T15), 30 (T30), 60 (T60) and 90 (T90) days after their discontinuation and in 527 patients ("controls") enrolled in the DULCIS study (all treated with warfarin), matched for sex, age (+/-3 y), type of D-dimer assay and site of venous thromboembolism. Both cases and controls received anticoagulant treatment after a first venous thromboembolism event that was unprovoked or associated with weak risk factors. Results The rate of positive D-dimer results was significantly higher in cases than in controls at T0 (10.8% vs 5.1%, p = 0.002) and at T30 (18.8% vs 11.8%, p = 0.019), as well as at the other time-points, though not statistically significant. Conclusion D-dimer levels during and after stopping an anticoagulant treatment for a venous thromboembolism episode differ between patients treated with a DOAC than in those treated with warfarin. Specifically designed prospective studies are warranted to reassess the use of D-dimer as predictor of the risk of recurrent venous thromboembolism in patients treated with DOACs.
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