ISTH Congress Abstracts

Official abstracts site for the ISTH Congress

MENU 

The effect of rivaroxaban on the diagnostic value of D-dimer

1University of Oslo, Norway and Østfold Hospital, Norway, Oslo, Oslo, Norway, 2Clinic of Internal Medicine, Østfold Hospital, Norway and Institute for Clinical Medicine, University of Oslo, Norway, Oslo, Oslo, Norway, 3Ostfold hospital, Sarpsborg, Ostfold, Norway, 4Sahlgrenska Hospital, Gothenburg, Vastra Gotaland, Sweden, 5Department of Multidisciplinary Laboratory Medicine and Medical Biochemistry, Akershus University Hospital, Norway, Lørenskog, Akershus, Norway, 6Clinic of Internal Medicine, Østfold Hospital, Norway, Department of Hematology, Oslo University Hospital and Institute for Clinical Medicine, University of Oslo, Norway, Sarpsborg, Ostfold, Norway

Abstract Number: PB0975

Meeting: ISTH 2022 Congress

Theme: Venous Thromboembolism » VTE Diagnosis

Background: Preemptive anticoagulation is widely used in the pre-diagnostic phase of deep vein thrombosis (DVT). In some parts of the world anticoagulation is administered prior to D-dimer testing. Direct oral anticoagulants (DOACs) have been shown to be a safe alternative empiric treatment to low-molecular weight heparin. However, the impact of DOACs on D-dimer in patients with suspected DVT is not well established.

Aims: This study aimed to determine the effect of empiric rivaroxaban on the diagnostic performance of D-dimer.

Methods: D-dimer was measured before and after the administration of one to two doses (15 mg) of rivaroxaban in 418 outpatients, referred with suspected DVT to the emergency department at Østfold hospital, Norway. To determine whether the effect of rivaroxaban significantly impacted D-dimer results, we calculated the diagnostic performance of the test before and after the administration of rivaroxaban.

Results: Median D-dimer values decreased from 1.0 mg/L (IQR, 0.7-2.2) to 0.9 mg/L (IQR, 0.6-2.0) and 286 (68.4%) of the patients had a decrease in D-dimer after administration of rivaroxaban. For the patients with decreased D-dimer, D-dimer decreased by 18.0% and 25.3% on average for the patients who took one and two tablets of rivaroxaban, respectively. Thirty-six patients (8.9%) with positive D-dimer (≥ 0.5 mg/L) before taking rivaroxaban had negative D-dimer values ( < 0.5 mg/L) after rivaroxaban intake (table 1). Of these, two had DVT diagnosed by CUS and had Wells scores of 2 and -2, respectively. The sensitivity of D-dimer decreased from 99.0% (95% CI, 94.6-99.8) to 97.0% (95% CI, 91.6-99.0) (table 1).

Conclusion(s): Rivaroxaban administered before measuring D-dimer may reduce D-dimer levels leading to false negative results and reduced sensitivity. As this study lacked a control group, caution is advised in interpretation of D-dimer results after the administration of rivaroxaban. Whether these results apply to other anticoagulant drugs should be examined in future trials.

Table 1.

D-dimer values and test performance before and after rivaroxaban.

To cite this abstract in AMA style:

Mohamad H, Vikum S, Jørgensen C, Tavoly M, Garabet L, Ghanima W. The effect of rivaroxaban on the diagnostic value of D-dimer [abstract]. https://abstracts.isth.org/abstract/the-effect-of-rivaroxaban-on-the-diagnostic-value-of-d-dimer/. Accessed October 2, 2023.

« Back to ISTH 2022 Congress

ISTH Congress Abstracts - https://abstracts.isth.org/abstract/the-effect-of-rivaroxaban-on-the-diagnostic-value-of-d-dimer/