D-dimer testing to determine the duration of anticoagulation therapy
D-dimer testing to determine the duration of anticoagulation therapy
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DOI：
10.1056/nejmoa054444
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发表时间：
2006-10-26
影响因子：
158.5
通讯作者：
Tripodi, Armando
中科院分区：
文献类型：
--
作者：
Palareti, Gualtiero;Cosmi, Benilde;Tripodi, Armando
背景：特发性静脉血栓栓塞患者口服抗凝治疗的最佳持续时间尚不确定。检测d -二聚体水平可能在评估是否需要延长抗凝治疗中发挥作用。方法：我们对首次非诱发性近端深静脉血栓形成或肺栓塞且服用维生素K拮抗剂至少3个月的患者在停用抗凝治疗1个月后进行d -二聚体检测。d -二聚体水平正常的患者不恢复抗凝治疗，而d -二聚体水平异常的患者被随机分配恢复或停止治疗。在平均1.4年的随访期间，研究结果是静脉血栓栓塞复发和大出血的综合结果。结果：608例患者中d -二聚体检测异常223例（36.7%）。120例停止抗凝治疗的患者共发生18例事件（15.0%），103例恢复抗凝治疗的患者共发生3例事件（2.9%），调整后的风险比为4.26（95%可信区间[CI]， 1.23 ~ 14.6； P=0.02）。385例d -二聚体水平正常的患者中有24例血栓栓塞复发（6.2%）。在停止抗凝治疗的患者中，与d -二聚体水平正常的患者相比，d -二聚体水平异常的患者复发血栓栓塞的校正危险比为2.27 （95% CI， 1.15至4.46；P=0.02）。结论：停用抗凝治疗1个月后d -二聚体水平异常的患者静脉血栓栓塞复发发生率显著升高，恢复抗凝治疗可降低该发生率。d -二聚体水平正常的患者的最佳抗凝疗程尚未明确确定。
BACKGROUND:The optimal duration of oral anticoagulation in patients with idiopathic venous thromboembolism is uncertain. Testing of D-dimer levels may play a role in the assessment of the need for prolonged anticoagulation.METHODS:We performed D-dimer testing 1 month after the discontinuation of anticoagulation in patients with a first unprovoked proximal deep-vein thrombosis or pulmonary embolism who had received a vitamin K antagonist for at least 3 months. Patients with a normal D-dimer level did not resume anticoagulation, whereas those with an abnormal D-dimer level were randomly assigned either to resume or to discontinue treatment. The study outcome was the composite of recurrent venous thromboembolism and major bleeding during an average follow-up of 1.4 years.RESULTS:The D-dimer assay was abnormal in 223 of 608 patients (36.7%). A total of 18 events occurred among the 120 patients who stopped anticoagulation (15.0%), as compared with 3 events among the 103 patients who resumed anticoagulation (2.9%), for an adjusted hazard ratio of 4.26 (95% confidence interval [CI], 1.23 to 14.6; P=0.02). Thromboembolism recurred in 24 of 385 patients with a normal D-dimer level (6.2%). Among patients who stopped anticoagulation, the adjusted hazard ratio for recurrent thromboembolism among those with an abnormal D-dimer level, as compared with those with a normal D-dimer level, was 2.27 (95% CI, 1.15 to 4.46; P=0.02).CONCLUSIONS:Patients with an abnormal D-dimer level 1 month after the discontinuation of anticoagulation have a significant incidence of recurrent venous thromboembolism, which is reduced by the resumption of anticoagulation. The optimal course of anticoagulation in patients with a normal D-dimer level has not been clearly established.