Systematic review: D-dimer to predict recurrent disease after stopping anticoagulant therapy for unprovoked venous thromboembolism
Systematic review: D-dimer to predict recurrent disease after stopping anticoagulant therapy for unprovoked venous thromboembolism
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DOI：
10.7326/0003-4819-149-7-200810070-00008
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发表时间：
2008-10-07
影响因子：
39.2
通讯作者：
Lim, Wendy
中科院分区：
文献类型：
--
作者：
Verhovsek, Madeleine;Douketis, James D.;Lim, Wendy
背景：对于首次发作的无端静脉血栓栓塞（VTE），抗凝治疗的最佳持续时间尚不确定。预测复发风险的方法可能会识别低风险患者谁是不太可能受益于长期antagonization.Purpose：合成证据评估的价值D-二聚体作为预测复发性疾病的患者谁已经停止抗凝治疗后，第一次无端VTE.Data来源：MEDLINE，EMBASE，CINAHL，和科克伦数据库进行了检索，直到2008年3月，没有语言限制。研究选择：随机对照试验或前瞻性队列研究，在接受抗凝治疗至少3个月的非诱发性VTE患者中，测量抗凝治疗后的D-二聚体。数据提取：两位作者独立审查文章并提取数据。数据综合：7项研究，共计1888例首次发生无端VTE的患者，符合分析条件。在4500人年的随访中，VTE复发的年发生率差异有统计学意义：8.9%（95% CI，5.8%-11.9%），在D-二聚体结果阳性的患者和3.5%（CI，2.7%至4.3%）。局限性：抗凝治疗的持续时间、D-二聚体检测的时间和D-二聚体测定在不同研究中存在差异。对于首次发生的非诱因性VTE已完成至少3个月抗凝治疗且随访约2年的患者，D-二聚体结果阴性与3.5%的年复发风险相关，而D-二聚体结果阳性与8.9%的年复发风险相关。这些发生率应告知延长抗凝治疗的风险和受益平衡的决策。
Background: The optimal duration of anticoagulation for a first episode of unprovoked venous thromboembolism (VTE) is uncertain. Methods for predicting risk for recurrence may identify lowrisk patients who are less likely to benefit from prolonged anticoagulation.Purpose: To synthesize evidence evaluating the value of D-dimer as a predictor of recurrent disease in patients who have stopped anticoagulant therapy after a first unprovoked VTE.Data Sources: The MEDLINE, EMBASE, CINAHL, and Cochrane databases were searched until March 2008 without language restrictions. The strategy was supplemented with manual review of reference lists and contact with content experts.Study Selection: Randomized, controlled trials or prospective cohort studies that measured D-dimer after anticoagulant therapy in patients who received at least 3 months of anticoagulant treatment of unprovoked VTE.Data Extraction: Two authors independently reviewed articles and extracted data.Data Synthesis: Seven studies, totaling 1888 patients with a first unprovoked VTE, were eligible for analysis. During 4500 personyears of follow up, annual rates of recurrent VTE differed statistically significantly: 8.9% (95% CI, 5.8% to 11.9%) in patients with positive D-dimer results and 3.5% (CI, 2.7% to 4.3%) in patients with negative D-dimer results.Limitation: The duration of anticoagulation, timing of D-dimer testing, and D-dimer assay varied across studies.Conclusion: In patients who have completed at least 3 months of anticoagulation for a first episode of unprovoked VTE and after approximately 2 years of follow-up, a negative D-dimer result was associated with a 3.5% annual risk for recurrent disease, whereas a positive D-dimer result was associated with an 8.9% annual risk for recurrence. These rates should inform decisions about the balance of risks and benefits of prolonging anticoagulation.