OC 23.2 - Serial D-dimers after anticoagulant cessation in unprovoked venous thromboembolism: data from the REVERSE cohort study

Sunday, July 10, 2022

3:00 PM – 3:15 PM

Location: ExCel Center, ICC Capital Suite Room 7&12

Presentation Format: In-Person

Presenting Author(s)

Yan Xu, MD

Thrombosis Fellow
University of Ottawa
Ottawa, Ontario, Canada

Co-Author(s)

Faizan Khan, MSc

Postdoctoral Fellow
University of Calgary
Ottawa, Ontario, Canada
MK

Michael J. Kovacs

MD
Division of Hematology, Department of Medicine, University of Western Ontario, London, Ontario, Canada.
London, Ontario, Canada
ES

Elham Sabri

Professor
University of Geneva
Ottawa, Ontario, Canada
Marc Righini, MD

MD
Division of Angiology and Hemostasis, Geneva University Hospital and Faculty of Medicine, Geneva, Switzerland
Geneve, Geneve, Switzerland
Marc Carrier, MD

MD, MSc
Ottawa Hospital Research Institute, Ottawa, ON, Canada
Ottawa, Ontario, Canada
SK

Susan R. Kahn

MD, MSc
McGill University, Montreal, QC, Canada
Montreal, Quebec, Canada
PW

Philip S. Wells

MD, MSc
Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada
Ottawa, Ontario, Canada
DA

David R. Anderson

Professor
Dalhousie University
Halifax, Nova Scotia, Canada
IC

Isabelle Chagnon

Professor
University of Montreal
Montreal, Quebec, Canada
MC

Mark Crowther, MD MSc

Professor
Department of Medicine, McMaster University
Hamilton, Ontario, Canada
RW

Richard White

Professor
University of California, Davis
Davis, California, United States
MR

Marc A. Rodger

Professor
Department of Medicine, McGill University, McGill University Health Center, Montreal, Quebec, Canada
Montreal, Quebec, Canada
Gregoire Le Gal, MD PhD

MD, PhD
Ottawa Hospital Research Institute, University of Ottawa, Canada
Ottawa, Ontario, Canada

Background: While several risk stratification tools have been developed to predict the risk of recurrence in patients with an unprovoked venous thromboembolism (VTE), only 1 in 4 patients are categorized as low-risk. Rather than a one-time measure, serial D-dimer assessment holds promise to enhance the prediction of VTE recurrence after oral anticoagulant (OAC) cessation.

Aims: To assess the effectiveness and safety of serial D-dimer measurement following OAC cessation, and to assess prediction of VTE recurrence using D-dimer levels on and off OAC.

Methods: Using data from the REVERSE cohort, we compared VTE recurrence among patients with normal D-dimer levels (defined as VIDAS D-dimer < 500 ng/mL in fibrinogen-equivalent units) at OAC cessation and 1-month follow-up, to those with an elevated D-dimer level at either time point. We also evaluated VTE recurrence based on absolute increase in D-dimer levels between the two timepoints (e.g., ΔD-dimer) according to quartiles.

Results: Among 214 patients with serial D-dimer levels measured at OAC cessation and 1-month follow-up, an elevated D-dimer level at either timepoint was associated with a numerically higher risk of recurrent VTE than patients with normal D-dimer levels (6.9% vs. 4.2% per year, hazards ratio 1.6, 95% CI 0.9-2.7). Among women with < 2 HERDOO2 risk factors, a normal D-dimer level predicted very low risk of recurrence during follow-up (0.8% per year, 95% CI 0.1–2.8). Similarly, recurrent VTE risk was 3% per year (95% CI 1.4–5.6) among patients in the lowest ΔD-dimer quartile, despite 1 in 4 in the group having D-dimer above cutoff values (Table).

Conclusion(s): Serial normal D-dimer levels identifies patients at a lower risk of VTE recurrence. In addition, ΔD-dimer, irrespective of its elevation above cutoff threshold, might predict VTE recurrence. Prospective validation of ΔD-dimer on VTE recurrence is needed to identify subgroups who may safely discontinue OACs within populations considered to be at high-risk.