| Related Articles |
The risk of a first and recurrent venous thrombosis associated with elevated D-dimer and Thrombin Potential; results of THE-VTE Study.
J Thromb Haemost. 2015 Jul 14;
Authors: van Hylckama Vlieg A, Baglin CA, Luddington R, MacDonald S, Rosendaal FR, Baglin TP
Abstract
BACKGROUND: D-dimer and thrombin generation have been associated with the risk of recurrent venous thrombosis. However, for both measurements different assays are available and in-vitro thrombin generation may be affected by the problem of contact activation during blood sampling.
OBJECTIVES: The aim was to determine the association between hypercoagulability and first and recurrent thrombosis using different D-dimer and thrombin generation assays; to assess whether addition of corn trypsin inhibitor (CTI) prior to blood sampling to inhibit contact activation improved the association between thrombin generation and thrombosis risk; and to calculate the DASH score using two different D-dimer assays.
METHODS: A case-control study (626 patients and 361 controls) with subsequent follow-up of the cases was performed (2987 patient-years after stopping anticoagulant therapy). Blood was drawn 2-3 months after discontinuation of anticoagulation for the first event in citrate tubes with and without CTI.
RESULTS/CONCLUSIONS: Elevated D-dimer and thrombin generation were associated with an increased risk of a first event regardless of the assay used (Odds ratios: 1.8-3.4). Elevated D-dimer but not thrombin generation was associated with the risk of recurrence. Patients with an elevated D-dimer had a more than 2-fold increased recurrence rate (D-dimer: Vidas(®) HR 2.3, 95%CI 1.4-3.8, HemosIL(®) HR 2.4, 95%CI1.5-3.9; Thrombinoscope and Technoclone assay: HR 1.3). Elimination of contact factor activation did not improve the predictive value of thrombin generation. In patients with unprovoked first events, the DASH score had a similar predictive value for DVT and PE, both when calculated using Vidas D-dimer or HemosIL D-dimer. This article is protected by copyright. All rights reserved.
PMID: 26178257 [PubMed - as supplied by publisher]