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D-dimer levels at diagnosis and long-term clinical outcomes in venous thromboembolism: from the COMMAND VTE Registry.
- Source :
-
Journal of thrombosis and thrombolysis [J Thromb Thrombolysis] 2020 May; Vol. 49 (4), pp. 551-561. - Publication Year :
- 2020
-
Abstract
- The relationship between D-dimer level at diagnosis and long-term clinical outcomes has not been fully evaluated in venous thromboembolism (VTE). The COMMAND VTE Registry is a multicenter registry enrolling consecutive acute symptomatic VTE patients in Japan. Patients with available D-dimer levels at diagnosis (N = 2852) were divided into 4 groups according to the D-dimer levels; Quartile 1 (0.0-4.9 µg/mL): N = 682, Quartile 2 (5.0-9.9 µg/mL) N = 694, Quartile 3 (10.0-19.9 µg/mL) N = 710, and Quartile 4 (≥ 20.0 µg/mL): N = 766. The cumulative incidence of all-cause death was higher in Quartile 4 throughout the entire follow-up period (19.9%, 24.9%, 28.8%, and 41.5% at 5-year, P < 0.0001), as well as both within and beyond 30-day. After adjustment, the excess risk of Quartile 4 relative to Quartile 1 for all-cause death remained significant (HR 1.60, 95% CI 1.29-2.03). Similarly, the excess risk of Quartile 4 relative to Quartile 1 for recurrent VTE was significant (HR 1.57, 95% CI 1.02-2.41), which was more prominent in the cancer subgroup. The dominant causes of death in Quartile 4 were pulmonary embolism within 30-day, and cancer beyond 30-day. In conclusions, in VTE patients, elevated D-dimer levels at diagnosis were associated with the increased risk for both short-term and long-term mortality. The higher mortality risk of patients with highest D-dimer levels was driven by the higher risk for fatal PE within 30-day, and by the higher risk for cancer death beyond 30-day. Elevated D-dimer levels were also associated with the increased risk for long-term recurrent VTE, which was more prominent in patients with active cancer.
- Subjects :
- Aged
Aged, 80 and over
Biomarkers blood
Female
Humans
Japan epidemiology
Male
Middle Aged
Neoplasms blood
Neoplasms mortality
Pulmonary Embolism mortality
Retrospective Studies
Venous Thromboembolism mortality
Fibrin Fibrinogen Degradation Products metabolism
Neoplasms complications
Pulmonary Embolism blood
Registries
Venous Thromboembolism blood
Subjects
Details
- Language :
- English
- ISSN :
- 1573-742X
- Volume :
- 49
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Journal of thrombosis and thrombolysis
- Publication Type :
- Academic Journal
- Accession number :
- 31571121
- Full Text :
- https://doi.org/10.1007/s11239-019-01964-0