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Rivista di Angiologia

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2003 December;22(4):364-9

lingua: Inglese

Potential use of D-dimer measurement in patients treated with oral anticoagulant for a venous thromboembolic episode

Ombandza-Moussa E., Samama M. M., Horellou M. H., Elalamy I., Conard J.

Department of Bio­log­i­cal Hem­a­tol­o­gy, Hôtel Dieu Hos­pi­tal, Uni­ver­sity of Paris, Paris, ­France


Aim. We com­pared the level of plas­ma D-dimer in ­patients with pre­vi­ous ­venous throm­boem­bo­lism (VTE), receiv­ing or not oral anti­co­ag­u­lant treat­ment (OAT) and inves­ti­gat­ed its pre­dic­tive value for the risk of VTE recur­rence after OAT with­draw­al.
Meth­ods. We have stud­ied 149 ­patients, 81 receiv­ing oral anti­co­ag­u­lants and 68 after treat­ment inter­rup­tion. ­Patients with known caus­es of D-dimer ­increase were exclud­ed. D-dimer meas­ure­ments were per­formed by Vidas ana­lyz­er (bioMérieux, ­France).
­Results. A sig­nif­i­cant­ly lower D-dimer plas­ma level was found in ­patients under OAT than in untreat­ed ­patients, 197±134 ng/ml ver­sus 399±239 ng/ml, respec­tive­ly (p<0.001). This ­decrease was sim­i­lar in the dif­fer­ent age pop­u­la­tions and wheth­er the ­patient had throm­bo­phil­ia (n=84) or not. There was no cor­re­la­tion ­between INR and D-dimer lev­els.
Dur­ing a mean fol­low-up of 30 ­months, no recur­rence ­occurred in ­patients under OAT ver­sus 7 untreat­ed ­patients. Among them, 3 had a D-dimer below 500 ng/ml, and 3 oth­ers had a level above 500 ng/ml. The last ­patient was not test­ed.
Con­clu­sion. The phy­si­cian ­should be ­informed of the ­decrease of D-dimer under OAT, since the usual cut-off of 500 ng/ml used for deep vein thrombosis (DVT) exclu­sion is prob­ably lower in such treat­ed ­patients. It has been recent­ly pro­posed that nor­mal D-dimer level had a high neg­a­tive pre­dic­tive value for VTE recur­rence when this dos­age was per­formed 3 ­months after OAT inter­rup­tion. The small num­ber of recur­renc­es ­observed in our study with an avail­able ­result of D-dimer meas­ured more than 3 ­months after OAT dis­con­tin­u­a­tion does not allow a def­i­nite con­clu­sion.

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