Title

Long-term risk of recurrence in patients with a first unprovoked venous thromboembolism managed according to D-dimer results; a cohort study.

Document Type

Article

Publication Date

4-29-2019

Publication Title

Journal of thrombosis and haemostasis : JTH

Abstract

BACKGROUND: The long-tem risk of recurrence in patients with a first unprovoked venous thromboembolism (VTE) who have negative D-dimer results is uncertain. OBJECTIVES: To determine this risk, including in subgroups based on sex. PATIENTS AND METHODS: ln a prospective interventional cohort study of 410 patients with a first unprovoked VTE, anticoagulants were stopped if D-dimer was negative on therapy and 1 month after stopping therapy. Other patients remained on anticoagulant therapy. We previously reported findings after a mean of 2.2 years. The current report includes 3 years of additional follow-up in 293 of these patients. RESULTS: During a median follow-up of 5.0 years, recurrent VTE after stopping therapy in response to negative D-dimer testing was 5.1% (95% CI 3.6% to 6.5%) per patient-year overall, 7.5% (95% CI 5.5% to 10.0%) in men, 3.8% (95% CI 2.0% to 6.6%) in women with VTE not associated with estrogens, and 0.4% (95% CI 0.0% to 2.3%) in women with VTE associated with estrogens (p<0.001 for 3-group comparison). Risk of recurrence at 5 years was 21.5% (95% CI 16.4% to 26.5%) overall, 29.7% (95% CI 22.1% to 37.3%) in men, 17.0% (95% CI 8.1% to 25.9%) in non-estrogen women, and 2.3% (95% CI 0.0% to 6.8%) in estrogen-women. CONCLUSION: The long-term risk of recurrence in patients with a first unprovoked VTE who have negative D-dimer results is not low enough to justify stopping anticoagulant therapy in men, but appears to be low enough in women for many to choose stopping therapy (ClinicalTrials.gov; NCT00720915). This article is protected by copyright. All rights reserved.

PubMed ID

31033194

ePublication

ePub ahead of print

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