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

Abstract

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.

Targeting protein disulfide isomerase with the flavonoid isoquercetin to improve hypercoagulability in advanced cancer

“…Elevations of plasma D-dimer are associated with an increased risk of thrombosis, especially in cancer populations (30,35). Therapeutic anticoagulation with direct oral anticoagulants reduces D-dimer by approximately 20%, which is similar to the percentage decrease we observed at the 1000-mg dose of isoquercetin (36,37).…”

Evaluation of the predictive value of the bleeding prediction score VTE‐BLEED for recurrent venous thromboembolism

“…On the other hand, patients with active cancer‐associated VTE are candidates for extended anticoagulation in light of the substantial risk for recurrence. However, the benefit of long‐term anticoagulation is not fully established because of their concomitant high risk of bleeding …”

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

“…We appreciate the comment of Dr. Klok and colleagues on our recent publication about D-dimer and high-sensitivity C-reactive protein (CRP) levels to predict venous thromboembolism recurrence after discontinuation of anticoagulation for cancer-associated thrombosis (CAT). 1 In our study, these biomarkers predicted VTE recurrence among patients with CAT, at 21 days after stopping anticoagulation treatment.…”