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Can D-dimer Levels Help to Predict VTE Recurrence?

Low D-dimer levels portend good prognoses for patients with idiopathic VTE.

It is difficult to predict risk for recurrent venous thromboembolism (VTE) precisely and, therefore, to assess whether prolonged anticoagulation therapy is appropriate. Austrian researchers prospectively followed 610 adults at a single center to determine the predictive value of measuring D-dimer levels 3 weeks after discontinuation of anticoagulation. Each patient had suffered a first spontaneous VTE (with no clear predisposing risk factors) and had been anticoagulated for at least 3 months. Mean follow-up was 38 months.

After anticoagulation discontinuation, D-dimer levels were significantly higher among the 79 patients (13%) who experienced VTE recurrence during follow-up (mean, 553 ng/mL) than among those who did not (mean, 427 ng/mL). Compared with the 70 patients whose D-dimer levels were 750 ng/mL, the 209 patients with levels of <250 ng/mL had a significantly lower relative risk for VTE recurrence (RR, 0.3), even after adjustment for potentially confounding variables (e.g., factor V Leiden status). The estimated cumulative 2-year probability of recurrent VTE was significantly lower among the patients with D-dimer levels of <250 ng/mL (3.7%) than among the 401 patients with levels of 250 ng/mL (11.5%).

Comment: For a patient with a first spontaneous VTE, the authors suggest that a D-dimer level of <250 ng/mL (measured 3 weeks after stopping anticoagulation therapy) signals low risk for recurrence, lack of need to screen extensively for thrombophilic risk factors, and, by implication, lack of need for prolonged anticoagulation. However, a 2-year risk for VTE recurrence of 3.7% still might warrant discussing the risks and benefits of this less aggressive approach with some patients whose D-dimer levels are low. These findings should be corroborated at other centers.

— Thomas L. Schwenk, MD

Published in Journal Watch General Medicine September 9, 2003

Citation(s):

Eichinger S et al. D-dimer levels and risk of recurrent venous thromboembolism. JAMA 2003 Aug 27; 290:1071-4.

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