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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1997;17:1320-1324.)
© 1997 American Heart Association, Inc.

Articles

D-Dimer and Anticoagulation in Patients With Mechanical Prosthetic Heart Valves

A 2-Year Follow-up

Carlo Giansante; Nicola Fiotti; Salvatore Calabrese; Rosa La Verde; Claudio Pandullo; Sabino Scardi; ; Gianfranco Guarnieri

From the Institute of Clinical Medicine, University of Trieste, and the Cardiovascular Centre, Ospedale Maggiore (C.P., S.S.), Trieste, Italy.

Abstract The best anticoagulation level in patients with mechanical heart valve prostheses is still being debated. D-dimer, which detects the presence of cross-linked fibrin degradation products, has been demonstrated to be a useful marker of coagulation activation. This study was designed to verify whether heart valve prostheses in anticoagulated patients are associated with abnormalities in D-dimer plasma levels, and if so, whether such levels are related to the anticoagulation level and/or whether they could be predictive of acute vascular or hemorrhagic events. In 132 patients with single and 10 with double mechanical valve replacement, international normalized ratio (INR) and D-dimer plasma levels were determined. The INR levels of the previous 8 months were reviewed to assess the time that each patient spent in the therapeutic range. The D-dimer plasma levels were compared with those obtained from 102 matched control subjects. The patients were then followed up for 2 years to record acute vascular and hemorrhagic events. For the entire group, D-dimer plasma levels in patients were the same as those in the control group. Patients with double valve replacement had higher D-dimer plasma levels than either monovalvular implant patients or control subjects. Patients who had spent <75% of the time within the assigned anticoagulation range had higher values for D-dimer plasma levels (median, 270 vs 198 ng/mL, P=.02). The major determinants of D-dimer plasma levels were age (R²=.07, P=.009) and the percentage of time spent below the predetermined INR level (R²=.09, P=.001). During follow-up, 19 acute vascular and 16 hemorrhagic events occurred. High D-dimer tertile was the only parameter predicting the occurrence of thromboembolic events. In patients with mechanical heart valve prostheses, the D-dimer plasma level depended on the thoroughness of anticoagulation. Patients in the upper tertile of D-dimer values have an 5-fold risk of vascular thromboembolic events. D-dimer determination can therefore be useful in detecting patients who are at a higher risk of severe vascular events.

Key Words: fibrin degradation products • oral anticoagulants • thromboembolism • hemorrhage

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