• Gualtiero Palareti, Cristina Legnani, Emilia Antonucci, Benilde Cosmi, Daniela Poli, Sophie Testa, Alberto Tosetto, Walter Ageno, Anna Falanga, Piera Maria Ferrini, Vittorio Pengo, Paolo Prandoni, and DULCIS (D-dimer and ULtrasonography in Combination Italian Study) Investigators.
• Fondazione Arianna Anticoagulazione, Via Paolo Fabbri 1/3, 40138, Bologna, Italy. gualtiero.palareti@unibo.it.
• Intern Emerg Med. 2020 Apr 1; 15 (3): 453-462.

AbstractMale patients, especially the young, are at a higher risk of recurrent venous thromboembolism (RVTE) than females. Recent scientific reports show the use of D-dimer does not help predict RVTE risk in males. In the present report, we reviewed the data obtained in the DULCIS study (main report published in Blood 2014), focusing on D-dimer results recorded in non-elderly patients of both genders included in the study, and their relationship with RVTE events occurring during follow-up. Using specifically designed cutoff values for positive/negative interpretation, serial D-dimer measurements (performed during warfarin treatment and up to 3 months after discontinuation of anticoagulation) in 475 patients (males 57.3%) aged ≤ 65 years were obtained. D-dimer resulted positive in 46.3% and 30.5% of males and females, respectively (p = 0.001). Following management procedure, anticoagulation was stopped in 53.7% of males and 69.5% of females, who had persistently negative D-dimer results. The rate of subsequent recurrent events was 1.7% (95% CI 0.5-4.5%) and 0.4% (95% CI 0-2.5%) patient-years in males and females, respectively, with upper limits of confidence intervals always below the level of risk considered acceptable by international scientific societies for stopping anticoagulation (< 5%). In conclusion, using sensitive quantitative assays with specifically designed cutoff values and serial measurements during and after discontinuation of anticoagulation, D-dimer testing is useful to predict the risk of RVTE and is of help in deciding the duration of anticoagulation in both male and female adult patients aged up to 65 years.

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