Journal Article

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

Palareti, Gualtiero, Mastroiacovo, Daniela, Ciammaichella, Maurizio, Legnani, Cristina, Ciavarella, Alessandro, Martinelli, Ida, Testa, Sophie, Mumoli, Nicola, Poli, Daniela, Cosmi, Benilde, Ageno, Walter, Bucherini, Eugenio

2019

Overview

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. 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. 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. 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.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Administration, Oral / Aged / Antagonists / Anticoagulants / Anticoagulants - therapeutic use / Apixaban / Biology and Life Sciences / Blood tests / Care and treatment / Case-Control Studies / Clinical Laboratory Techniques - standards / Clinical Trials as Topic / Dimers / Embolisms / Female / Fibrin Fibrinogen Degradation Products - analysis / Health risk assessment / Hemophilia / Humans / Italy / Male / Martinelli, Ida / Measurement methods / Medicine and Health Sciences / Middle Aged / Patients / Pharmacodynamics / Pharmacokinetics / Pharmacology / Phylloquinone / Physical sciences / Pulmonary embolisms / Recurrence (Disease) / Retrospective Studies / Risk / Risk analysis / Risk factors / Rivaroxaban / Rivaroxaban - therapeutic use / Statistical analysis / Studies / Thromboembolism / Thrombosis / Veins & arteries / Venous Thromboembolism - blood / Venous Thromboembolism - drug therapy / Venous thrombosis / Vitamin K / Vitamin K - antagonists & inhibitors / Vitamin K - blood / Vitamins / Warfarin / Warfarin - therapeutic use