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Prepublished online as a Blood First Edition Paper on September 26, 2002; DOI 10.1182/blood-2002-05-1416.
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Blood, 15 February 2003, Vol. 101, No. 4, pp. 1243-1248
CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS
Fibrin fragment D-dimer and the risk of future venous
thrombosis
Mary Cushman,
Aaron R. Folsom,
Lu Wang,
Nena Aleksic,
Wayne D. Rosamond,
Russell P. Tracy, and
Susan R. Heckbert
From the Laboratory for Clinical Biochemistry Research
and Departments of Medicine, Pathology, and Biochemistry, University of
Vermont, Colchester; Division of Epidemiology, School of Public Health,
University of Minnesota, Minneapolis; Department of Internal Medicine,
University of Texas, Houston; Department of Epidemiology, University of
North Carolina, Chapel Hill; and Department of Epidemiology, University
of Washington, Seattle.
Plasma D-dimer concentration rises more than 100-fold
during acute deep vein thrombosis, but there are no prospective data concerning D-dimer as a risk factor for incident venous thrombosis in a
general population. Incident venous thrombosis was ascertained in 2 prospective observational studies, the Atherosclerosis Risk in
Communities Study and the Cardiovascular Health Study. Of 21 690
participants enrolled between 1987 and 1993, after 8 years of
follow-up, D-dimer was measured using baseline stored plasma of 307 participants who developed venous thrombosis and 616 who did not.
Relative to the first quintile of the distribution of D-dimer, the
age-adjusted odds ratios for future venous thrombosis for the second to
fifth quintiles of D-dimer were 1.6, 2.3, 2.3, and 4.2, respectively
(P for trend < .0001). Following added adjustment for
sex, race, body mass index, factor V Leiden, prothrombin 20210A, and
elevated factor VIII coagulant activity (factor VIII:c),
these odds ratios were 1.5, 2.1, 1.9, and 3.0, respectively
(P for trend < .0001). Among those with idiopathic
thrombosis or secondary thrombosis unrelated to cancer, the adjusted
fifth quintile odds ratios were 3.5 and 4.8, respectively. By contrast,
D-dimer in the fifth versus first quintile was not related to
occurrence of cancer-associated thrombosis (odds ratio, 1.1). Odds
ratios for elevated D-dimer were consistently elevated in subgroups
defined by age, sex, race, duration of follow-up, and thrombosis type (deep vein thrombosis or pulmonary embolus). D-dimer is strongly and
positively related to the occurrence of future venous thrombosis.

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