Residual Vein Thrombosis and D-Dimer for Optimizing Duration of Anticoagulation in Idiopathic Deep Vein Thrombosis

Alessandra      Malato; Giorgia      Saccullo; Alfonso      Iorio; Walter      Ageno; Sergio      Siragusa

doi:10.2174/138161210793563428

Abstract

Long-term anticoagulant treatment is highly effective in preventing recurrent Venous Thrombo-Embolism (VTE) in patients with idiopathic Deep Vein Thrombosis (DVT) of the lower limbs, though associated with an increased risk for major bleeding that may offset the benefits of anticoagulation. Accordingly to recent guidelines, patients with idiopathic DVT should be treated for at least 3 months and then should be evaluated for the risk-benefit ratio of long-term therapy. However, such ‘time for decision’ is often unclear and the optimal duration of VKA remains debatable. In recent studies, markers for the assessment of the individual risk for recurrent thrombosis have been proposed, which can be of help to establish the optimal duration of VKA treatment; among them, the D-dimer (D-d) assay and the Residual Vein Thrombosis (RVT) assessment by Compression Ultra-Sonography (CUS) were shown to be the most suitable. Studies results showed that negative results of these parameters after 3 to 6 months of therapy, identify a group of patients at low-risk for recurrent thrombosis in whom VKA treatment can be withheld. In the present review we will discuss advantages and potential limits of using these individual markers for the management of patients with a first episode of DVT of the lower limbs.

Keywords: DVT, residual vein thrombosis, D-Dimer, anticoagulation, Idiopathic Deep Vein Thrombosis, Venous Thrombo-Embolism, thrombosis, D-dimer (D-d) assay, Compression Ultra-Sonography, low-molecular weight-heparin, oral vitamin K an-tagonists, surgery, trauma, immobilization, cancer, paralysis, chronic diseases, warfarin therapy, pulmonary embolism, anticoagulant therapy, F2 G20210A (Prothrombin G20210A), F5 R506Q, Factor V Leiden, R506Q, thrombophilia, lupus anticoagulant, recent studies, antithrombotic treatment, recurrent venous thromboembolism, oral anticoagulation, low-intensity warfarin, Heterozygous Factor V Leiden, Prothrombin G20210A