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

• Published in: Journal of thrombosis and haemostasis Vol. 21; no. 7; pp. 1861 - 1868
• Main Authors: Rinde, Fridtjof B., Jørgensen, Camilla T., Pettersen, Heidi H., Hansen, John-Bjarne, Ghanima, Waleed, Braekkan, Sigrid K.
• Format: Journal Article
• Language: English
• Published: England Elsevier Inc 01-07-2023; Elsevier
• Subjects: Anticoagulants; D-dimer; epidemiology; Humans; prediction; recurrenc; Registries; Risk Factors; venous thromboembolism; Venous Thromboembolism - diagnosis; Venous Thromboembolism - epidemiology; D-dimer; prediction; epidemiology; venous thromboembolism; recurrenc
• ISSN: 1538-7836; 1538-7933; 1538-7836
• DOI: 10.1016/j.jtha.2023.03.026

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.
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.
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.
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.
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.
•Can D-dimer levels at incident venous thromboembolism (VTE) predict recurrence risk?•We explored the association in a cohort of 2585 patients with first symptomatic VTE.•Low D-dimer levels measured at incident VTE diagnosis were associated with a low risk of recurrence.•This implies that low D-dimer levels may be used to stratify patients with VTE already at diagnosis.