d -Dimer Testing in Patients With a First Unprovoked Venous Thromboembolism

Letters5 May 2015d-Dimer Testing in Patients With a First Unprovoked Venous ThromboembolismGualtiero Palareti, MDGualtiero Palareti, MDFrom Fondazione Arianna Anticoagulazione, Bologna, Italy.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-5089 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail TO THE EDITOR:In their study on d-dimer testing to assess the risk for recurrence of venous thromboembolism (VTE) in patients with a first unprovoked VTE, Kearon and colleagues (1) concluded that the risk for recurrence in patients with negative results was not low enough to justify stopping anticoagulation. I was impressed by the low rate of positive d-dimer results reported in the study (71 of 410 patients; 17.3%) and, as a result, by the high proportion of patients who remained without anticoagulation and therefore at higher risk for recurrence. d-Dimer testing was performed using a whole-blood qualitative assay (Clearview ...References1. Kearon C, Spencer FA, O'Keeffe D, Parpia S, Schulman S, Baglin T, et al; d-dimer Optimal Duration Study Investigators. d-dimer testing to select patients with a first unprovoked venous thromboembolism who can stop anticoagulant therapy: a cohort study. Ann Intern Med. 2015;162:27-34. [PMID: 25560712] doi:10.7326/M14-1275 LinkGoogle Scholar2. Palareti G, Cosmi B, Legnani C, Tosetto A, Brusi C, Iorio A, et al; PROLONG Investigators. d-dimer testing to determine the duration of anticoagulation therapy. N Engl J Med. 2006;355:1780-9. [PMID: 17065639] CrossrefMedlineGoogle Scholar3. Cosmi B, Legnani C, Tosetto A, Pengo V, Ghirarduzzi A, Testa S, et al; PROLONG Investigators (on behalf of Italian Federation of Anticoagulation Clinics). Usefulness of repeated d-dimer testing after stopping anticoagulation for a first episode of unprovoked venous thromboembolism: the PROLONG II prospective study. Blood. 2010;115:481-8. [PMID: 19965693] doi:10.1182/blood-2009-08-237354 CrossrefMedlineGoogle Scholar4. Palareti G, Legnani C, Cosmi B, Valdré L, Lunghi B, Bernardi F, et al. Predictive value of d-dimer test for recurrent venous thromboembolism after anticoagulation withdrawal in subjects with a previous idiopathic event and in carriers of congenital thrombophilia. Circulation. 2003;108:313-8. [PMID: 12847064] CrossrefMedlineGoogle Scholar5. Palareti G, Cosmi B, Legnani C, Antonucci E, De Micheli V, Ghirarduzzi A, et al; DULCIS (d-dimer and ULtrasonography in Combination Italian Study) Investigators. d-dimer to guide the duration of anticoagulation in patients with venous thromboembolism: a management study. Blood. 2014;124:196-203. [PMID: 24879813] doi:10.1182/blood-2014-01-548065 CrossrefMedlineGoogle Scholar6. Legnani C, Cini M, Cosmi B, Carraro P, Tripodi A, Erba N, et al. Age and gender specific cut-off values to improve the performance of d-dimer assays to predict the risk of venous thromboembolism recurrence. Intern Emerg Med. 2013;8:229-36. [PMID: 21584847] doi:10.1007/s11739-011-0608-5 CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Gualtiero Palareti, MDAffiliations: From Fondazione Arianna Anticoagulazione, Bologna, Italy.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=L15-0076. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee Alsod-Dimer Testing to Select Patients With a First Unprovoked Venous Thromboembolism Who Can Stop Anticoagulant Therapy Clive Kearon , Frederick A. Spencer , Denis O'Keeffe , Sameer Parpia , Sam Schulman , Trevor Baglin , Scott M. Stevens , Scott Kaatz , Kenneth A. Bauer , James D. Douketis , Steven R. Lentz , Craig M. Kessler , Stephan Moll , Jean M. Connors , Jeffrey S. Ginsberg , Luciana Spadafora , Jim A. Julian , and d-Dimer Testing to Select Patients With a First Unprovoked Venous Thromboembolism Who Can Stop Anticoagulant Therapy Clive Kearon , Frederick A. Spencer , Denis O'Keeffe , Sameer Parpia , Sam Schulman , Trevor Baglin , Scott M. Stevens , Scott Kaatz , Kenneth A. Bauer , James D. Douketis , Steven R. Lentz , Craig M. Kessler , Stephan Moll , Jean M. Connors , Jeffrey S. Ginsberg , Luciana Spadafora , Jim A. Julian , and d-Dimer Testing in Patients With a First Unprovoked Venous Thromboembolism Clive Kearon , Scott M. Stevens , and Jim A. Julian d-Dimer Testing in Patients With a First Unprovoked Venous Thromboembolism Clive Kearon , Scott M. Stevens , and Jim A. Julian Metrics Cited byThe venous thromboembolic risk and the clot wave analysis: a useful relationship?Optimal long-term pharmacological treatment of patients with venous thromboembolism that was unprovoked or associated with weak risk factorsManagement of idiopathic venous thromboembolismD-dimer levels and recurrence in patients with unprovoked VTE and a negative qualitative D-dimer test after treatment 5 May 2015Volume 162, Issue 9Page: 670-671KeywordsD-dimerDiagnostic techniquesDisclosureElderlyQualitative studiesRisk managementUltrasound imagingVenous thromboembolism ePublished: 5 May 2015 Issue Published: 5 May 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...