D-dimer and lower limb ultrasound as prognostic factors for recurrent deep venous thrombosis and pulmonary embolism: A systematic review and meta-analysis

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: OR 2.00 for residual vein thrombosis; OR 2.48 for positive D-dimer

• Primary Outcome: Recurrent venous thromboembolism

• Nnt Or Sensitivity: Two-fold increased risk for RVT; 2.48-fold increased risk for positive D-dimer

• Confidence Interval: RVT: 95% CI 1.02-3.94; D-dimer: 95% CI 1.85-3.33

Clinical Application

Both tests readily available in Australian healthcare system D-dimer and ultrasound widely accessible through Medicare; relevant to TGA-approved anticoagulants and RACGP VTE management guidelines Patients with completed VTE treatment considering anticoagulation duration

Abstract

Venous thromboembolic disease is a chronic, recurrent condition. The optimal duration of anticoagulation therapy remains uncertain. We aim to evaluate D-dimer and lower limb ultrasonography as prognostic tools for the recurrence of venous thromboembolism. A search was conducted on May 28, 2022, in the Medline, Embase, and Cochrane databases. Inclusion criteria encompassed cohort studies, case-control studies, and clinical trials. Two reviewers independently screened all records and analyzed studies for inclusion/exclusion criteria, as well as risk of bias, using a structured framework (PROSPERO ID: CRD42022341082). The initial search yielded 4652 titles and abstracts. After removing 777 duplicates and reviewing 3875 titles and abstracts, 48 articles providing information on D-dimer and/or lower limb ultrasonography as prognostic factors were finally included. Very low-certainty evidence suggests that both residual vein thrombosis (RVT) at anticoagulation discontinuation and a positive post-treatment D-dimer are significantly associated with an increased risk of recurrent venous thromboembolism (VTE). For RVT, the pooled analysis showed a two-fold increase in risk (OR 2.00, 95% CI 1.02 to 3.94; I² = 85.7) while for positive D-dimer, the risk was similarly elevated (OR, 2.48; 95% CI, 1.85-3.33; I² = 56.0). In conclusion, very low-quality evidence suggests that abnormal D-dimer and RVT are associated with recurrent VTE; however, this association is inconsistent due to significant heterogeneity and wide prediction intervals. These biomarkers should be interpreted with caution as isolated predictors in clinical practice.

References

1. 1.Salinas-Mendoza, S., Burgos Cárdenas, Á. J., & Rhenals, S. D. M. M. (2024). D-dimer and lower limb ultrasound as prognostic factors for recurrent deep venous thrombosis and pulmonary embolism: A systematic review and meta-analysis. PLoS One. https://doi.org/10.1371/journal.pone.0340158