D-dimer to Establish Duration of Anticoagulation After Venous Thromboembolism

Study Overview
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Brief Summary
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The optimal duration of oral anticoagulant treatment in patients with idiopathic venous thromboembolism is still uncertain. The present study addresses the possible role of the D-dimer test in assessing the need for continuation of anticoagulation.The study aims at assessing whether D-dimer assay may have a role in guiding the duration of anticoagulation in these patients

Detailed Description
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This is a multicenter prospective follow-up study in patients with a first episode of symptomatic idiopathic venous thromboembolism (proximal deep vein thrombosis and/or pulmonary embolism) who are treated with vitamin K antagonists (either warfarin or acenocoumarol) for a minimum of 3 months. Eligible patients who give informed consent are instructed to immediately stop oral anticoagulation and refrain from taking any other antithrombotic drugs until the next visit, scheduled after 30 days. At that visit, venous blood is sampled to perform D-dimer assay and thrombophilia tests. D-dimers are assessed using the Clearview Simplify D-dimer assay (Agen Biomedical Limited, Brisbane, Australia). Patients with normal D-dimer results do not continue anticoagulation, whereas those with elevated D-dimer results are randomized using a computer program to either stop or resume anticoagulation with vitamin K antagonists (INR 2.0-3.0). All patients are followed-up for 18 months. The study outcome are the composite of confirmed recurrent venous thromboembolism and major bleeding events. All suspected outcome events and all deaths are evaluated by a central adjudication committee whose members are unaware of the D-dimer and thrombophilia results and of the group assignments.

Official Title
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D-dimer Test to Establish Duration of Anticoagulation After a First Idiopathic Episode of Venous Thromboembolism; the Prospective Randomized Prolong Study

Conditions
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Deep Vein Thrombosis, Pulmonary Embolism

Intervention / Treatment
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* Drug: Vitamin K antagonist (Coumarin anticoagulants)


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Age > 18 years After a first documented idiopathic proximal deep vein thrombosis and/or pulmonary embolism After at least 3 months of oral anticoagulation After written informed consent Exclusion Criteria: If the Venous thromboembolism occurred: during pregnancy or puerperium after recent (i.e. within three months) fracture or plaster casting of a leg, after immobilization with confinement to bed for three consecutive days after surgery with general anesthesia lasting longer than 30 minutes Patients with: active cancer antiphospholipid antibody syndrome antithrombin deficiency serious liver disease or renal insufficiency (creatininemia > 2 mg/dL), other indications for anticoagulation or contraindications for this treatment limited life expectation Patients who live too far from the clinical center

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Treatment
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Drug: Vitamin K antagonist (Coumarin anticoagulants)|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Confirmed recurrent proximal deep vein thrombosis and/or pulmonary embolism at 18 months follow up |  |  | 
| Confirmed major bleeding events at 18 months follow up |  |  | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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D-dimer, Recurrence, Venous Thromboembolism, Anticoagulation, Duration