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A Journal on Phlebology
Acta Phlebologica 2006 August;7(2):69-73
D-dimer testing for diagnosis of venous thromboembolism (VTE) and for decision about duration of anticoagulation
Department of Angiology and Blood Coagulation “Marino Golinelli” University Hospital S. Orsola-Malpighi Bologna, Italy
D-dimer, the final product of the plasmin-mediated degradation of cross-linked fibrin, can be found in low concentrations in healthy subjects, and increased levels can be seen in many clinical conditions. For this reason, the test has high sensitivity but low specificity for VTE and can therefore be used only to exclude the presence of VTE in cases where values are below a validated cut-off level. A wide number of methods are available and results may differ between them. When choosing a method to use in VTE diagnosis strategies preference should be given to highly sensitive methods which have cut-off levels validated in clinical studies which enrolled patients with suspected VTE. Though highly sensitive for VTE, the test cannot, however, be used on its own to exclude VTE, but should be included in a diagnostic strategy together with the degree of clinical probability and execution of non-invasive instrumental tests. Recently, a new clinical use of D-dimer testing has been suggested. The optimal OAT duration after a first episode of VTE is still uncertain since the condition tends to recur after OAT withdrawal whatever the duration of treatment. The value of D-dimer as a marker of hypercoagulability and risk factor for recurrence after OAT withdrawal has recently been investigated, and its predictive value for recurrent VTE has been confirmed by several prospective studies. The recently published, randomized, controlled PROLONG study demonstrated that patients with a first episode of unprovoked VTE, who had completed at least three months of OAT and had an abnormal D-dimer assay one month after OAT withdrawal, had a higher rate of recurrent VTE (15.0%) than those with altered D-dimer who resumed anticoagulation (2.9 %; p= 0.005), and also higher than those who had a normal D-dimer assay (6.2%, p=0.005). This study for the first time showed that, there is a clear benefit of prolonging OAT in patients whose D-dimer test is abnormal one month after anticoagulation withdrawal.