Diagnostic accuracy of D-Dimer testing for recurrent venous thromboembolism: A systematic review with meta-analysis.: VTE recurrence and D-dimer |
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| Institution: | 1. Department of Translational Medical Sciences, Federico II University, Naples, Italy;2. Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy;3. Istituti Clinici Scientifici Maugeri IRCCS, Pavia, Italy;4. Department of Molecular Medicine and Medical Biotechnology Federico II University, Naples, Italy;5. Department of Pharmacy Federico II University Naples, Italy;1. Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA;2. Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA;3. Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA;4. Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA;1. Department of Gastroenterology and Hepatology, University Medical Center Utrecht, the Netherlands.;2. Department of Gastroenterology and Hepatology, Erasmus University Medical Center, Rotterdam, the Netherlands.;1. Department of Internal Medicine and Clinical Immunology, Regional Competence Center for Rare and Systemic Autoimmune Disease, Nancy University Hospital, Vand?uvre-lès-Nancy, France;2. Université de Lorraine, Vand?uvre-lès-Nancy, France;3. Vascular Medicine Division and Regional Competence Center for Rare Vascular and Systemic Autoimmune Diseases, Nancy University Hospital, Vand?uvre-lès-Nancy, France;4. Methodology, data management and statistics Unit, MPI department, Nancy University Hospital, Vand?uvre-lès-Nancy, France;5. INSERM, UMR_S 1116, Vand?uvre-lès-Nancy, France |
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| Abstract: | ObjectiveVenous thromboembolism (VTE) recurrence is a major concern after a first symptomatic episode, potentially impacting survival and healthcare needs in community, hospital and rehabilitation settings. We evaluated the association of D-Dimer positivity after oral anticoagulant therapy (OAT) discontinuation with VTE recurrence.MethodsPubMed, Web of Science, Scopus and EMBASE databases were systematically searched. Differences were expressed as Odds Ratio (OR) with 95% confidence intervals (95%CI). Pooled sensitivity, specificity, positive (PLR) and negative likelihood ratio (NLR), and summary ROC (sROC) curve were calculated.ResultsTwenty-six articles on 10,725 VTE patients showed that the absolute risk of recurrence was 16.1% (95%CI: 13.2%-19.5%) among 4,049 patients with a positive D-Dimer and 7.4% (95%CI: 6.0%-9.0%) in 6,676 controls (OR: 2.1, 95%CI: 1.7-2.8, P<0.001), with an attributable risk of 54.0%. sROC curve of the association between positive D-Dimer and recurrence showed a diagnostic AUC of 63.8 (95%CI: 60.3-67.4), with a pooled sensitivity of 54.3% (95%CI: 51.3%-57.3%), specificity of 64.2% (95%CI: 63.2-65.1), PLR of 1.53 (95%CI: 1.37-1.72), and NLR of 0.71 (95%CI: 0.60-0.84). Subgroup and meta-regression analyses suggested that a positive D-Dimer may have a higher discriminatory ability for patients with provoked events, confirmed by better pooled diagnostic indexes for recurrence and a diagnostic AUC of 70.6 (95%CI: 63.8-77.4). Regression models showed that the rate of OAT resumption after the evidence of D-Dimer positivity was inversely associated with VTE recurrence (Z-score: -3.91, P<0.001).ConclusionsD-Dimer positivity after OAT may identify VTE patients at higher risk of recurrence, with a better diagnostic accuracy for provoked events. |
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