AUTHOR=Migita Shohei , Okumura Yasuo , Fukuda Ikuo , Nakamura Mashio , Yamada Norikazu , Takayama Morimasa , Maeda Hideaki , Yamashita Takeshi , Ikeda Takanori , Mo Makoto , Yamazaki Tsutomu , Hirayama Atsushi 

TITLE=Relationship between baseline D-dimer and prognosis in Japanese patients with venous thromboembolism: Insights from the J’xactly study

JOURNAL=Frontiers in Cardiovascular Medicine

VOLUME=Volume 10 - 2023

YEAR=2023

URL=https://www.frontiersin.org/journals/cardiovascular-medicine/articles/10.3389/fcvm.2023.1074661

DOI=10.3389/fcvm.2023.1074661

ISSN=2297-055X

ABSTRACT=Background: D-dimer is a biomarker of fibrin production and degradation, and changes in D-dimer concentration suggest fibrin clot formation, which is associated with thromboembolism and hypercoagulable states. Thus, an elevated D-dimer concentration could be a useful prognostic predictor for patients with venous thromboembolism (VTE).
Methods and Results: In this subanalysis of the J’xactly study, a prospective multicenter study conducted in Japan, we examined the clinical outcomes of 949 patients with VTE stratified by baseline D-dimer concentration. The median D-dimer concentration was 7.6 µg/mL (low D-dimer group: <7.6 µg/mL [n = 473, 49.8%]; high D-dimer group: ≥7.6 µg/mL [n = 476, 50.2%]). The mean age of the patients was 68 years, and 386 patients (40.7%) were male. Compared with the low D-dimer group, the high D-dimer group had more frequent pulmonary embolism with or without deep vein thrombosis (DVT), proximal DVT, atrial fibrillation, or diabetes mellitus, and underwent intensive treatment with 30 mg/day rivaroxaban. The incidence of composite clinically relevant events (recurrence or exacerbation of symptomatic VTE, acute coronary syndrome [ACS], ischemic stroke, death from any cause, or major bleeding) was higher in the high D-dimer group than in the low D-dimer group (11.1% vs. 7.5% per patient-year; hazard ratio, 1.46; 95% confidence interval, 1.05–2.04; P = 0.025). There was no significant difference between the high and low D-dimer groups in the incidence of VTE (2.8% vs. 2.5% per patient-year, respectively; P = 0.788), ACS (0.4% per patient-year vs. not observed, respectively; P = 0.078), or major bleeding (4.0% vs. 2.1% per patient-year, respectively; P = 0.087), but there was a significant difference in the incidence of ischemic stroke (1.0% per patient-year vs. not observed, respectively; P = 0.004).
Conclusions: Elevated D-dimer concentration may be an important prognostic predictor in Japanese patients with VTE.