D-dimer and high-sensitivity C-reactive protein levels to predict venous thromboembolism recurrence after discontinuation of anticoagulation for cancer-associated thrombosis

Identifier:  imarina:5651864

Handle: https://hdl.handle.net/20.500.11797/imarina5651864

Authors:  Jara-Palomares L; Solier-Lopez A; Elias-Hernandez T; Asensio-Cruz M; Blasco-Esquivias I; Sanchez-Lopez V; de la Borbolla M; Arellano-Orden E; Suarez-Valdivia L; Marin-Romero S; Marin-Barrera L; Ruiz-Garcia A; Montero-Romero E; Navarro-Herrero S; Lopez-Campos J; Serrano-Gotarredona M; Praena-Fernandez J; Sanchez-Diaz J; Otero-Candelera R

Abstract:
© 2018, Cancer Research UK. Background: Optimal duration of anticoagulation for cancer-associated thrombosis (CAT) remains unclear. This study assessed D-dimer (DD) and high-sensitivity C-reactive protein (hs-CRP) levels after the withdrawal of anticoagulation treatment to predict the risk of venous thromboembolism (VTE) recurrence among patients with CAT. Methods: Prospective, multicentre study to evaluate CAT with ≥3 months of anticoagulation that was subsequently discontinued. Blood samples were taken when patients stopped the anticoagulation and 21 days later to determine the DD and hs-CRP levels. All patients were followed up for 6 months to detect VTE recurrence. Results: Between 2013 and 2015, 325 patients were evaluated and 114 patients were ultimately enrolled in the study. The mean age was 62 ± 14 years and nearly 40% had metastasis. Ten patients developed VTE recurrence within 6 months (8.8%, 95% confidence interval [CI]: 4.3–15.5%). The DD and hs-CRP levels after 21 days were associated with VTE recurrence. The subdistribution hazard ratios were 9.82 for hs-CRP (95% CI: 19–52) and 5.81 for DD (95% CI: 1.1–31.7). Conclusions: This study identified that hs-CRP and DD were potential biomarkers of VTE recurrence after discontinuation of anticoagulation in CAT. A risk-adapted strategy could identify low-risk patients who may benefit from discontinuation of anticoagulation.