ABSTRACT
Venous thromboembolism (VTE) requires prolonged treatment to prevent late recurrences.
However, the optimal duration of vitamin K antagonist (VKA) therapy is still controversial.
More recently, D-dimer (D-d) has emerged as a predictive factor for recurrences. D-d
has been evaluated both during and after VKA treatment. Some patients with DVT of
the lower limbs have persistently high D-d during anticoagulation and this could reflect
insufficient anticoagulation despite apparently adequate antithrombotic treatment.
Altered D-d during anticoagulation is more frequent in patients with idiopathic or
cancer-associated VTE than in those with secondary VTE. In subjects with an unprovoked
VTE event, the time spent at near normal international normalization ratio (INR) values
(< 1.5) during the first 3 months of treatment is associated with higher D-d during
and after VKA treatment and with a higher risk for late recurrences. Moreover, the
combination of altered D-d and inherited thrombophilia, and not residual venous obstruction,
is associated with a significantly higher hazard ratio for recurrence. Preliminary
results of a management study, the PROLONG study, indicate that subjects with normal
D-d at 1 month after VKA withdrawal have a low risk of recurrence, and those with
altered D-d have a significantly higher risk and deserve prolonged treatment.
KEYWORDS
Warfarin - venous thromboembolism - recurrence - thrombosis - fibrin degradation products
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Gualtiero PalaretiM.D.
Department of Angiology & Blood Coagulation “Marino Golinelli,” S. Orsola-Malpighi
University Hospital
Via Albertoni 15, 40138 Bologna, Italy