Background: While several risk stratification tools have been developed to predict the risk of recurrence in patients with an unprovoked venous thromboembolism (VTE), only 1 in 4 patients are categorized as low-risk. Rather than a one-time measure, serial D-dimer assessment holds promise to enhance the prediction of VTE recurrence after oral anticoagulant (OAC) cessation.
Aims: To assess the effectiveness and safety of serial D-dimer measurement following OAC cessation, and to assess prediction of VTE recurrence using D-dimer levels on and off OAC.
Methods: Using data from the REVERSE cohort, we compared VTE recurrence among patients with normal D-dimer levels (defined as VIDAS D-dimer < 500 ng/mL in fibrinogen-equivalent units) at OAC cessation and 1-month follow-up, to those with an elevated D-dimer level at either time point. We also evaluated VTE recurrence based on absolute increase in D-dimer levels between the two timepoints (e.g., ΔD-dimer) according to quartiles.
Results: Among 214 patients with serial D-dimer levels measured at OAC cessation and 1-month follow-up, an elevated D-dimer level at either timepoint was associated with a numerically higher risk of recurrent VTE than patients with normal D-dimer levels (6.9% vs. 4.2% per year, hazards ratio 1.6, 95% CI 0.9-2.7). Among women with < 2 HERDOO2 risk factors, a normal D-dimer level predicted very low risk of recurrence during follow-up (0.8% per year, 95% CI 0.1–2.8). Similarly, recurrent VTE risk was 3% per year (95% CI 1.4–5.6) among patients in the lowest ΔD-dimer quartile, despite 1 in 4 in the group having D-dimer above cutoff values (Table).
Conclusion(s): Serial normal D-dimer levels identifies patients at a lower risk of VTE recurrence. In addition, ΔD-dimer, irrespective of its elevation above cutoff threshold, might predict VTE recurrence. Prospective validation of ΔD-dimer on VTE recurrence is needed to identify subgroups who may safely discontinue OACs within populations considered to be at high-risk.
Table
Table. Risk of VTE recurrence based on change in D-dimer from baseline.
To cite this abstract in AMA style:
Xu Y, Khan F, Kovacs M, Sabri E, Righini M, Carrier M, Kahn S, Wells P, Anderson D, Chagnon I, Crowther M, White R, Rodger M, Le Gal G. Serial D-dimers after anticoagulant cessation in unprovoked venous thromboembolism: data from the REVERSE cohort study [abstract]. https://abstracts.isth.org/abstract/serial-d-dimers-after-anticoagulant-cessation-in-unprovoked-venous-thromboembolism-data-from-the-reverse-cohort-study/. Accessed August 16, 2022.« Back to ISTH 2022 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/serial-d-dimers-after-anticoagulant-cessation-in-unprovoked-venous-thromboembolism-data-from-the-reverse-cohort-study/