1. Age and gender specific cut-off values to improve the performance of D-dimer assays to predict the risk of venous thromboembolism recurrence
- Author
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Armando Tripodi, Paolo Carraro, Nicoletta Erba, Cristina Legnani, Gualtiero Palareti, Michela Cini, Benilde Cosmi, Legnani C, Cini M, Cosmi B, Carraro P, Tripodi A, Erba N, and Palareti G.
- Subjects
Adult ,Male ,medicine.medical_specialty ,Vitamin K ,VITAMIN K ANTAGONISTS ,law.invention ,Fibrin Fibrinogen Degradation Products ,Young Adult ,Sex Factors ,Randomized controlled trial ,Anticoagulation, d-dimer, Recurrence, Risk factors, Venous thromboembolism ,Fibrinolytic Agents ,law ,Predictive Value of Tests ,Recurrence ,Risk Factors ,Internal medicine ,D-dimer ,Internal Medicine ,Medicine ,Humans ,Young adult ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Age Factors ,Retrospective cohort study ,Venous Thromboembolism ,Middle Aged ,Surgery ,Predictive value of tests ,Emergency Medicine ,Female ,Fresh frozen plasma ,business ,Venous thromboembolism ,Fibrinolytic agent - Abstract
The Prolong study shows that continuing vitamin K antagonists (VKA) in patients with abnormal D: -dimer (evaluated by a qualitative assay, Clearview Simplify D: -dimer) results in a significant reduction of venous thromboembolism (VTE) recurrence. The present study retrospectively analyzes a subgroup of patients enrolled in the Prolong study with a view to calculate cut-off values for six quantitative D: -dimer methods to predict the risk of VTE recurrence. We measured D: -dimer levels by VIDAS D: -dimer Exclusion (bioMerieux), STA Liatest D: -dimer (DiagnosticaStago), HemosIL D: -dimer and HemosIL D: -dimer HS (Instrumentation Laboratory), Innovance D: -dimer (Siemens) and AutoDimer (Trinity Biotech) in frozen plasma aliquots sampled 30 ± 10 days after VKA cessation in 390 patients enrolled in the Prolong study. During follow-up (562.7 years), 28 patients had recurrent VTE (7.2%, 5.0% person-years). Since D: -dimer levels are positively correlated with age and significantly lower in men, we calculated method-specific cut-off values according to age and gender. The HRs for VTE recurrence calculated using method-specific cut-off values based on age and gender are higher than those using cut-off values indicated by the manufacturers for VTE exclusion in symptomatic outpatients. These data suggest that method-specific cut-off values calculated according to patient age and gender can be more accurate in identifying patients at a higher risk for VTE recurrence. These method-specific cut-off values are being evaluated in the ongoing prospective management multicenter DULCIS study.
- Published
- 2011