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. 2015 Oct;136(4):781-5.
doi: 10.1016/j.thromres.2015.08.013. Epub 2015 Aug 28.

Prospective study of plasma D-dimer and incident venous thromboembolism: The Atherosclerosis Risk in Communities (ARIC) Study

Aaron R Folsom  1 , Alvaro Alonso  2 , Kristen M George  2 , Nicholas S Roetker  2 , Weihong Tang  2 , Mary Cushman  3
Affiliations

Prospective study of plasma D-dimer and incident venous thromboembolism: The Atherosclerosis Risk in Communities (ARIC) Study

Aaron R Folsom et al. Thromb Res. 2015 Oct.

Abstract

Introduction: Plasma D-dimer is a useful clinical test for acute venous thromboembolism (VTE), and concentrations remain higher in VTE patients after treatment than in controls. Yet, evidence is limited on whether higher basal D-dimer concentrations in the general population are associated with greater risk of first VTE.

Objective: To assess the prospective association between D-dimer and incident VTE over a long follow-up.

Methods: We measured plasma D-dimer in 12,097 participants, initially free of VTE, in the Atherosclerosis Risk in Communities Study. Over a median follow-up of 17years, we identified 521 VTEs. We calculated hazard ratios of VTE using proportional hazards regression.

Results: The age, race, and sex adjusted hazard ratios of VTE across quintiles of D-dimer were 1, 1.5, 1.8, 2.1, and 3.2 (p for trend <0.0001). For the first 10years of follow-up, the hazard ratio for the highest versus lowest quintile was 3.5, and was 2.9 after 10years. In both whites and African Americans, VTE risk remained strongly associated with D-dimer after further adjustment for diabetes, body mass index, kidney function, and several thrombophilia genetic markers. D-dimer was associated with both unprovoked and provoked VTE, but more strongly with unprovoked.

Conclusions: A higher basal level of plasma D-dimer in the general population, presumably reflecting a predisposition to thrombosis, is a strong, long-term risk factor for a first VTE.

Keywords: D-dimer; Deep vein thrombosis; Prospective studies; Pulmonary embolism; Risk factors.

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Figures

Figure 1
Figure 1
Survival free of venous thromboembolism (VTE) in relation to quintiles of plasma D-dimer, ARIC, 1993-2011
Figure 2
Figure 2
Age, race, sex-adjusted hazard ratio of venous thromboembolism in relation to logarithm-transformed D-dimer*, ARIC, 1993-2011 * Analyzed using restricted cubic splines with knots at the fifth, fiftieth, and ninety-fifth percentiles of the log D-dimer distribution.
See this image and copyright information in PMC

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