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Predictive Value of D-Dimer Test, Persistent Residual Venous Thrombosis, and Thrombophilia for Venous Thromboembolism Recurrence

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Author(s): Luca Spiezia | Paolo Prandoni

Journal: The Asia-Pacific Journal of Oncology & Hematology
ISSN 1759-6637

Volume: 2;
Issue: 1;
Start page: 57;
Date: 2010;
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Keywords: residual vein thrombosis | thrombophilia | venous thromboembolism | deep vein thrombosis | recurrence | risk factor | D dimer

ABSTRACT
The optimal duration of anticoagulation aimed at preventing recurrence of venous thromboembolism (VTE) in patients presenting with deep venous thrombosis (DVT) of the lower extremities is unknown. In recent years, a number of studies have been conducted in an attempt to identify predictors of recurrent VTE in order to tailor the duration of oral anticoagulant therapy (OAT). Several baseline characteristics of the index event (type of presentation, location of VTE, age, gender, inherited thrombophilia, cancer, antiphospholipid syndrome, etc.) have been extensively evaluated as predictive of recurrence. More recently, post-basal conditions have been considered as possible risk factors for recurrent VTE. In particular, the positivity of D-dimer after OAT withdrawal and the persistence of thrombus burden, as shown by repeated ultrasonography over time, have been found to be predictors of recurrent VTE in patients with DVT. In carriers of thrombophilia, who develop an episode of proximal DVT, the thrombus mass persists for a longer time than in non-carriers. This finding supports the view that persistent residual thrombosis is to be regarded as a possible marker of hypercoagulability. Further studies are needed to clarify the pathophysiology of this feature and to evaluate its clinical implications.
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