Low D-dimer levels at diagnosis of venous thromboembolism are associated with reduced risk of recurrence: data from the TROLL registry

Fridtjof B Rinde; Camilla T Jørgensen; Heidi H Pettersen; John-Bjarne Hansen; Waleed Ghanima; Sigrid K Braekkan

doi:10.1016/j.jtha.2023.03.026

Low D-dimer levels at diagnosis of venous thromboembolism are associated with reduced risk of recurrence: data from the TROLL registry

J Thromb Haemost. 2023 Jul;21(7):1861-1868. doi: 10.1016/j.jtha.2023.03.026. Epub 2023 Mar 31.

Authors

Fridtjof B Rinde¹, Camilla T Jørgensen², Heidi H Pettersen³, John-Bjarne Hansen⁴, Waleed Ghanima⁵, Sigrid K Braekkan⁴

Affiliations

¹ Thrombosis Research Center (TREC), Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway; Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway. Electronic address: fridtjof.b.rinde@uit.no.
² Internal Medicine Clinic, Østfold Hospital, Kalnes, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
³ Internal Medicine Clinic, Østfold Hospital, Kalnes, Norway.
⁴ Thrombosis Research Center (TREC), Division of Internal Medicine, University Hospital of North Norway, Tromsø, Norway; Thrombosis Research Group (TREC), Department of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway.
⁵ Internal Medicine Clinic, Østfold Hospital, Kalnes, Norway; Department of Hematology, Oslo University Hospital, Oslo, Norway.

PMID: 37004791
DOI: 10.1016/j.jtha.2023.03.026

Abstract

Background: Venous thromboembolism (VTE) is a frequent disease with a high risk of recurrence. It has been suggested that the D-dimer level at the time of VTE diagnosis can be used to identify patients at a low risk of recurrence.

Objectives: We aimed to investigate the impact of D-dimer levels measured at the time of VTE diagnosis on the risk of recurrence in a large cohort of patients with a first-time VTE.

Methods: The study included 2585 patients with first symptomatic non-cancer-associated VTE from the Venous Thrombosis Registry in Østfold Hospital (TROLL) (2005-2020). All recurrent events during the follow-up were recorded, and cumulative incidences of recurrence were estimated according to D-dimer levels of ≤1900 ng/mL (≤25th percentile) and >1900 ng/mL.

Results: During a median follow-up of 3.3 years, 395 patients experienced a recurrent VTE. The 1- and 5-year cumulative incidences of recurrence were 2.9% (95% CI: 1.8-4.6) and 11.4% (95% CI: 8.7-14.8), respectively, in those with a D-dimer concentration of ≤1900 ng/mL and 5.0% (95% CI, 4.0-6.1) and 18.3% (95% CI: 16.2-20.6), respectively, in those with a D-dimer concentration of >1900 ng/mL, respectively. In patients with unprovoked VTE, the 5-year cumulative incidence was 14.3% (95% CI: 10.3-19.7) in the ≤1900-ng/mL category, and 20.2% (95% CI: 17.3-23.5) in the >1900-ng/mL category.

Conclusions: D-dimer levels within the lowest quartile, measured at the time of VTE diagnosis, were associated with lower recurrence risk. Our findings imply that D-dimer levels measured at the time of diagnosis may be used to identify patients with VTE at a low risk of recurrent VTE.

Keywords: D-dimer; epidemiology; prediction; recurrenc; venous thromboembolism.

Publication types

Research Support, Non-U.S. Gov't
Comment

MeSH terms

Anticoagulants
Humans
Registries
Risk Factors
Venous Thromboembolism* / diagnosis
Venous Thromboembolism* / epidemiology

Substances

fibrin fragment D
Anticoagulants