ROLE OF D-DIMER IN COMBINATION WITH F1+2, RVO AND THROMBOPHILIA IN THE RISK OF RECURRENCE OF PATIENTS WITH A FIRST VTE EPISODE AFTER OAT WITHDRAWA
Abstract number: P-T-545
Poli1 D., Antonucci1 E., Falciani1 M., Lucarini1 L., Evangelisti1 L., Pucci1 N., Poli1 S., Abbate1 R., Gensini2 G., Prisco1 D.
11Dept of Medical and Surgical Critical Care, Thrombosis Centre, Azienda Ospedaliero-Universitaria, Azienda Ospedaliero-Universitaria Careggi, Florence 22Dept of Medical and Surgical Critical Care, Thrombosis Centre, Azienda Ospedaliero-Universitaria, Don Carlo Gnocchi Foundation, ONLUS, IRCCS, Florence, Italy
How-to-cite Poli D, Antonucci E, Falciani M, Lucarini L, Evangelisti L, Pucci N, Poli S, Abbate R, Gensini G, Prisco D. ROLE OF D-DIMER IN COMBINATION WITH F1+2, RVO AND THROMBOPHILIA IN THE RISK OF RECURRENCE OF PATIENTS WITH A FIRST VTE EPISODE AFTER OAT WITHDRAWA. J Thromb Haemost 2007; 5 Supplement 2: P-T-545
Abstract
Introduction: The evaluation of predictors of venous thromboembolism (VTE) recurrence at the time of oral anticoagulant (OA) withdrawal is of clinical relevance. Several parameters have been evaluated: the presence of common thrombophilia, D-dimer, F1+2 and the presence of residual vein obstruction (RVO), but few studies have evaluated the role of the combination of these parameters as predictors of recurrence. The purpose of our study was to assess if the risk of VTE recurrence could be better predicted with the association of reported parameters
Methods: We prospectively investigated 311 patients, follow-up 25 months (1-120 months), with a first episode of VTE after at least 3 months of OA treatment. Patients with cancer or antiphospholipid antibodies were excluded. One month after stopping OA all patients were screened for common thrombophilia, D-dimer and F1+2 plasma levels and RVO was measured at compression ultrasonography.
Results: VTE recurrence was recorded in 38 patients (12.2%). No relationship was found between common thrombophilia and VTE recurrence (p=0.5). Both D-dimer and F1+2 were significantly associated with VTE recurrence (p<0.001 and p=0.04 respectively), with a positive predictive value (PPV) of 21.3% and 21% respectively. RVO was found in 108 patients (39.6%) and it was not associated with VTE recurrence (p=0.5). The presence of abnormal D-dimer had OR 4.0 (95% CI 1.8-8.8, p=0.001). The combination of abnormal D-dimer, with altered F1+2 had OR 4.9 (95% CI 1.9-12.7, p=0.001). This combination had PPV 33%. The combination of abnormal D-dimer, with altered F1+2 and RVO had OR 6.4 (95% CI 1.68-26.2, p=0.009) and PPV was 44%. The presence of common thrombophilia with all the above mentioned parameters was not related to VTE recurrence.
Conclusions: In conclusion, the contemporary measurement of F1+2 and RVO increases the predictive value of D-dimer for recurrence after a first episode of VTE.
