摘要
背景:自发性静脉血栓栓塞患者应用口服抗凝剂的最佳持续时间尚不明确。D-二聚体水平检测可能在评估是否需要长期抗凝中具有作用。
BACKGROUND:The optimal duration of oral anticoagulation in patients with idiopathic venous thromboembolism is uncertain. Testing of D-dimer levels may play a role in the assessment of the need for prolonged anticoagulation. METHODS:We performed D-dimer testing 1 month after the discontinuation of anticoagulation in patients with a first unprovoked proximal deep-vein thrombosis or pulmonary embolism who had received a vitamin K antagonist for at least 3 months. Patients with a normal D-dimer level did not resume anticoagulation,whereas those with an abnormal D-dimer level were randomly assigned either to resume or to discontinue treatment. The study outcome was the composite of recurrent venous thromboembolism and major bleeding during an average follow-up of 1.4 years. RESULTS:The D-dimer assay was abnormal in 223 of 608 patients(36.7%). A total of 18 events occurred among the 120 patients who stopped anticoagulation(15.0%),as compared with 3 events among the 103 patients who resumed anticoagulation(2.9%),for an adjusted hazard ratio of 4.26(95%confidence intervalCI,1.23 to 14.6; P=0.02). Thromboembolism recurred in 24 of 385 patients with a normal D-dimer level(6.2%). Among patients who stopped anticoagulation,the adjusted hazard ratio for recurrent thromboembolism among those with an abnormal D-dimer level,as compared with those with a normal D-dimer level,was 2.27(95%CI,1.15 to 4.46; P=0.02). CONCLUSIONS:Patients with an abnormal D-dimer level 1 month after the discontinuation of anticoagulation have a significant incidence of recurrent venous thromboembolism,which is reduced by the resumption of anticoagulation. The optimal course of anticoagulation in patients with a normal D-dimer level has not been clearly established.
