Unprovoked recurrent venous thrombosis: prediction by D‐dimer and clinical risk factors

Background: The aim of the study was to determine the predictive value of D‐dimer measurement for unprovoked recurrent venous thrombosis and the influence of sex, age and type of first event (unprovoked or provoked). Methods: Prospective cohort study of 272 patients with a first episode of venous th...

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Bibliographic Details
Published in:Journal of thrombosis and haemostasis 2008-04, Vol.6 (4), p.577-582
Main Authors: BAGLIN, T., PALMER, C. R., LUDDINGTON, R., BAGLIN, C.
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Aged, 80 and over
Anticoagulants - therapeutic use
Confounding Factors (Epidemiology)
Contraceptives, Oral, Combined
Contraceptives, Oral, Hormonal
Contraindications
deep vein thrombosis
D‐dimer
Enoxaparin - therapeutic use
Female
Fibrin Fibrinogen Degradation Products - analysis
Follow-Up Studies
Humans
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
pulmonary embolus
Recurrence
Risk Factors
Stockings, Compression
Thrombophlebitis - blood
Thrombophlebitis - epidemiology
Thrombophlebitis - therapy
thrombosis
Venous Thrombosis - blood
Venous Thrombosis - drug therapy
Venous Thrombosis - epidemiology
Venous Thrombosis - prevention & control
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Summary:Background: The aim of the study was to determine the predictive value of D‐dimer measurement for unprovoked recurrent venous thrombosis and the influence of sex, age and type of first event (unprovoked or provoked). Methods: Prospective cohort study of 272 patients with a first episode of venous thrombosis that was unprovoked or provoked by a non‐surgical trigger. Findings: The cumulative rate of unprovoked recurrence in patients with a positive D‐dimer was 20% at 5 years [5.5/100 patient‐years, 95% confidence interval (CI) 3.7–7.8] and in patients with a negative D‐dimer 17% (4.1/100 patient‐years, 95% CI 2.3–6.9). The rates are not different (hazard ratio 1.3, 95% CI 0.7–2.5). After adjustment for clinical risk factors a positive D‐dimer result was significantly associated with an increased risk of unprovoked recurrent thrombosis (hazard ratio 2.0, 95% CI 1.01–3.9). The strongest indicator of risk of recurrence was male sex (hazard ratio 3.3 unadjusted and 2.9 after adjustment). The only determinant of D‐dimer in a linear regression model was age (P 
ISSN:1538-7933
1538-7836
1538-7836
DOI:10.1111/j.1538-7836.2008.02889.x