VTE Recurrence After Negative D-Dimer Testing

Patients with unprovoked venous thromboembolism (VTE) have a higher risk for recurrence than VTE patients with provoking risk factors and are considered candidates for indefinite anticoagulation. However, it has been proposed that patients with unprovoked VTE and negative D-dimer testing may have a lower risk for recurrence and the option for limited, rather than indefinite, anticoagulation.

To test this hypothesis, investigators prospectively followed a cohort of 319 patients with unprovoked VTE who were anticoagulated an average of 5 months, had a negative D-dimer during treatment, and had a second negative D-dimer 1 month after stopping anticoagulation. Rates of symptomatic recurrent VTE — proximal deep venous thrombosis (DVT) or pulmonary embolism (PE) — were compared among men, women with estrogen-associated VTE, and women without estrogen-associated VTE.

Results at a mean 5.0 years of follow-up were as follows:

• The overall VTE recurrence rate was 5.1% per patient-year; the 5-year cumulative risk for recurrence was 21.5%.

• In men, the VTE recurrence rate was 7.5% per patient-year; the 5-year cumulative risk for recurrence was 29.7%.

• In women without estrogen-associated VTE, the VTE recurrence rate was 3.8% per patient-year; the 5-year cumulative risk for recurrence was 17.0%.

• In women with estrogen-associated VTE, the VTE recurrence rate was 0.4% per patient-year; the 5-year cumulative risk for recurrence was 2.3%.