ISTH Congress Abstracts

Official abstracts site for the ISTH Congress

MENU 

Serial D-dimers after anticoagulant cessation in unprovoked venous thromboembolism: data from the REVERSE cohort study

1University of Ottawa, Ottawa, Ontario, Canada, 2Division of Hematology, Department of Medicine, University of Western Ontario, London, Ontario, Canada, London, Ontario, Canada, 3University of Geneva, Ottawa, Ontario, Canada, 4Division of Angiology and Hemostasis, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland, Geneva, Geneve, Switzerland, 5University of Ottawa at The Ottawa Hospital and Ottawa Hospital Research Institute, Ottawa, Ontario, Canada, 6Division of Internal Medicine, Department of Medicine, McGill University, Montreal, Québec, Canada, Montreal, Quebec, Canada, 7Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada, Ottawa, Ontario, Canada, 8Dalhousie University, Halifax, Nova Scotia, Canada, 9University of Montreal, Montreal, Quebec, Canada, 10McMaster University, Department of Medicine, Hamilton, Ontario, Canada, 11University of California, Davis, Davis, California, United States, 12Department of Medicine, McGill University, McGill University Health Center, Montreal, Quebec, Canada, Montreal, Quebec, Canada

Abstract Number: OC 23.2

Meeting: ISTH 2022 Congress

Theme: Venous Thromboembolism » VTE Treatment

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/