| Patient-level meta-analysis: effect of measurement timing, threshold, and patient age on ability of D-dimer testing to assess recurrence risk after unprovoked venous thromboembolism. | |
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MedLine Citation:
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PMID: 20956709 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: In patients with a first unprovoked venous thromboembolism (VTE), an elevated d-dimer level after anticoagulation is stopped is a risk factor for recurrent VTE. However, questions remain about the utility of measuring d-dimer in clinical practice. PURPOSE: To determine whether the timing of testing, patient age, and the cut point used to define a positive or negative result affect the ability of d-dimer testing to distinguish risk for recurrent disease. DATA SOURCES: Comprehensive search of electronic databases (MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials) until July 2010, supplemented by reviewing conference abstracts and contacting content experts. STUDY SELECTION: 7 prospective studies that investigated an association between d-dimer, measured after stopping anticoagulation, and disease recurrence in patients with a first unprovoked VTE (proximal deep venous thrombosis, pulmonary embolism, or both). DATA EXTRACTION: Patient-level databases were obtained, transferred to a central database, checked, completed with further information provided by study investigators, and pooled into a single database. DATA SYNTHESIS: 1818 patients with a first unprovoked VTE were followed for a mean of 26.9 months (SD, 19.1). A study-stratified multivariate Cox regression model, which included patient age, sex, hormone therapy use at the time of the index event, body mass index, timing of postanticoagulation d-dimer testing, and inherited thrombophilia as possible confounders, indicated that the hazard ratio for d-dimer status (positive vs. negative) was 2.59 (95% CI, 1.90 to 3.52). Only male sex had a significant effect on risk for recurrent VTE independent of d-dimer status. The Cox regression model and the log-rank test confirmed that the risk for recurrent VTE was higher in patients with a positive d-dimer result than in those with a negative result, regardless of the timing of postanticoagulation d-dimer testing or patient age. No study- or assay-specific d-dimer effect was found, and reassessing the analysis after recoding data according to specific quantitative d-dimer cut points (500 µg/L and 250 µg/L) did not change the results. LIMITATIONS: Unmeasured variables could have affected the risk for recurrent VTE. The study population was predominantly white. CONCLUSION: In patients with a first unprovoked VTE who have their d-dimer level measured after stopping anticoagulation, the timing of d-dimer testing, patient age, and the assay cut point used do not affect the ability of d-dimer to distinguish patients with a higher or lower risk for recurrent VTE. |
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Authors:
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James Douketis; Alberto Tosetto; Maura Marcucci; Trevor Baglin; Mary Cushman; Sabine Eichinger; Gualtiero Palareti; Daniela Poli; R Campbell Tait; Alfonso Iorio |
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Publication Detail:
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Type: Journal Article; Meta-Analysis; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Review |
Journal Detail:
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Title: Annals of internal medicine Volume: 153 ISSN: 1539-3704 ISO Abbreviation: Ann. Intern. Med. Publication Date: 2010 Oct |
Date Detail:
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Created Date: 2010-10-19 Completed Date: 2010-11-22 Revised Date: 2011-06-17 |
Medline Journal Info:
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Nlm Unique ID: 0372351 Medline TA: Ann Intern Med Country: United States |
Other Details:
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Languages: eng Pagination: 523-31 Citation Subset: AIM; E; IM |
Affiliation:
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McMaster University, Hamilton, Ontario, Canada. jdouket@mcmaster.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Adult Age Factors Aged Aged, 80 and over Anticoagulants / therapeutic use* Biological Markers / blood Female Fibrin Fibrinogen Degradation Products / analysis* Humans Male Middle Aged Proportional Hazards Models Recurrence Risk Factors Sex Factors Time Factors Venous Thromboembolism / blood*, drug therapy Withholding Treatment Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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HL-57951/HL/NHLBI NIH HHS; HL-58036/HL/NHLBI NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Anticoagulants; 0/Biological Markers; 0/Fibrin Fibrinogen Degradation Products; 0/fibrin fragment D |
| Comments/Corrections | |
Comment In:
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Ann Intern Med. 2011 May 3;154(9):644; author reply 644
[PMID:
21536944
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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