D-dimer levels and risk of recurrence following provoked venous thromboembolism: findings from the RIETE registry

O Avnery, M Martin, A Bura-Riviere, G Barillari, L Mazzolai, I Mahé, P J Marchena, P Verhamme, M Monreal, M H Ellis (Coresponding Author), RIETE Investigators, Andris Skride (Member of the Working Group), Valdis Ģībietis (Member of the Working Group)

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)


BACKGROUND: Patients with venous thromboembolism (VTE) secondary to transient risk factors may develop VTE recurrences after discontinuing anticoagulation. Identifying at-risk patients could help to guide the duration of therapy.

METHODS: We used the RIETE database to assess the prognostic value of d-dimer testing after discontinuing anticoagulation to identify patients at increased risk for recurrences. Transient risk factors were classified as major (postoperative) or minor (pregnancy, oestrogen use, immobilization or recent travel).

RESULTS: In December 2018, 1655 VTE patients with transient risk factors (major 460, minor 1195) underwent d-dimer measurements after discontinuing anticoagulation. Amongst patients with major risk factors, the recurrence rate was 5.74 (95% CI: 3.19-9.57) events per 100 patient-years in those with raised d-dimer levels and 2.68 (95% CI: 1.45-4.56) in those with normal levels. Amongst patients with minor risk factors, the rates were 7.79 (95% CI: 5.71-10.4) and 3.34 (95% CI: 2.39-4.53), respectively. Patients with major risk factors and raised d-dimer levels (n = 171) had a nonsignificantly higher rate of recurrences (hazard ratio [HR]: 2.14; 95% CI: 0.96-4.79) than those with normal levels. Patients with minor risk factors and raised d-dimer levels (n = 382) had a higher rate of recurrences (HR: 2.34; 95% CI: 1.51-3.63) than those with normal levels. On multivariate analysis, raised d-dimers (HR: 1.74; 95% CI: 1.09-2.77) were associated with an increased risk for recurrences in patients with minor risk factors, not in those with major risk factors.

CONCLUSIONS: Patients with raised d-dimer levels after discontinuing anticoagulant therapy for VTE provoked by a minor transient risk factor were at an increased risk for recurrences.

Original languageEnglish
Pages (from-to)32-41
Number of pages10
JournalJournal of Internal Medicine
Issue number1
Publication statusPublished - Jan 2020
Externally publishedYes


  • Age Factors
  • Anticoagulants/therapeutic use
  • Female
  • Fibrin Fibrinogen Degradation Products/analysis
  • Humans
  • Male
  • Middle Aged
  • Prognosis
  • Recurrence
  • Registries
  • Risk Factors
  • Venous Thromboembolism/blood

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 1.1. Scientific article indexed in Web of Science and/or Scopus database


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