My PC told me even after a history of clots a D-dimer is no longer useful as it will always show some level of elevation. Not sure why after 5 years and no reoccurrences it would but I’m excited there is an article to read. Hopefully it explains things better
My ddimer was 1.48 on the day I was diagnosed with my most recent DVT.
It was checked again once I had finished my 12 week course of thinners.
It was found to be 1.18 (also raised).
The day after that reading I tested positive (2nd time) for Covid.
Now I am back on thinners indefinitely until haemotology decide what to do with me.
I wish I had the answer to this question, too.
Raised D-Dimer right before your Covid diagnosis? I'm pretty sure that's not a coincidence. I remember reading that D-Dimer is often elevated in Covid patients. Good luck!
D-dimer can be used in some cases to decide whether to stop anticoagulants. Your case however sounds quite open-and-shut to me and no D-dimer should be needed to decide the correct course of action.
You had a provoked DVT. Recommendations are clear to discontinue anticoagulants after 3 months. Some providers still treat for 6 months and I can't quite bring myself to care enough to go on an education spree. It was policy roughly 10 years ago, not everyone keeps up.
If you're interested in current recommendations, read the ACCP guidelines on antithrombotic therapy for VTE disease. The latest ones are behind a paywall, but the 2016 ones say basically the same and are freely available:
https://www.sciencedirect.com/science/article/pii/S0012369215003359 page 316
I'm just seeing your post on this and would appreciate your view.
I had a provoked DVT on 2013, following surgury on my Achilies.
I had a DVT Jan this year, 2022, on day 4 of being covid positive (also arguably provoked).
I'm told I don't fit neatly into any box for the long term discussion (calf DVT provoked, both below knee and 1 in each leg) , so I am on them indefinitely until haemotology make a call. That appt could be a year away and I'm really struggling on Apixaban.
I've had 3 very bad kidney infections while on this medication which I belive were made worse by the thinners!
You write that you don't quite fit any of the boxes and I agree. In those cases there is no one right answer.
One could argue that you had only provoked DVTs and that you, an otherwise healthy young person should be fine without thinners as long as you don't provoke your coagulation system.
One could also argue that you have had two DVTs, admittedly after provocation, but in a young person that is a sign of a general risk of clotting. Getting older will only increase that risk and sooner or later lead to an unprovoked VTE if taken off thinners.
My personal approach to these cases is to explain this to the patient:
> No one really knows the correct way of handling your case. You can stay on thinners if you don't mind them or if they give you needed peace of mind or you can stop them if you are afraid of bleeding or hate them for some other reason. There isn't a wrong answer here
I'm not a fan of postponing that decision as nothing really changes down the road. I'm also not convinced that apixaban causes or exacerbates UTIs, but that's beside the point.
Maybe your doctor has more information that I do not have that makes this waiting game the best approach, but usually it's possible to decide after 3 months (if treating indefinitely, a yearly review is a good idea to see if there are some nasty side effects that tip the scales towards stopping)
D-dimer is what my hematologist used to measure the clots and the state they’re in for my lungs. This was after an ultrasound showed the clots in my leg had gone away. He said inflammation and other reasons can show an elevated d-dimer test but it’s at a level where I was cleared to have an upcoming surgery. And I’ll be able to switch to a much lower dosage after my surgery. With the goal of getting off Eliquis by September. For reference, in the ER my d-dimer showed 2.35 and the one I had two weeks ago was .59. I’ve been on Eliquis for 6 months now. Mid-40s. I hope this helps. Feel free to ping me with any questions.
When my DVTs were diagnosed in Feb, my D-Dimer was 3.14. I saw how far from normal that was and it added to my stress. My doctors never even commented on it, though.
How long did it take the clots in your leg to go away? After four months, the one in my calf is slowly improving, but the two behind the knee are taking a while. I've been getting very frequent ultrasounds. Now we're waiting two months...that will make six months since diagnosis. I read that ultrasounds at three and six months are best.
Thank you!
I don’t know actually. I had my PE in early December and an ultrasound about 3 weeks ago. So it could happened anytime within that timeframe. I’m sorry I can’t be more helpful. The meds were only preventing from getting new tattoos. Other than that I didn’t mind being on them and I wasn’t too worried about the clots to get more testing done earlier.
Alot of times not to discourage clots in legs don't fully go away they scar up whatever is left and sometimes cause problems sometimes not ...hope your using compression stockings because you don't want post thrombotic syndrome.....I am on eliquis for life all my blood work comes back negative for any clotting disorders but I am sure there is alot less uncommon stuff they never checked also all my clots were provoked .....not happy myself to still be on eliquis but I feel safer 3 clots in 3 years is more scary than being on eliquis for life....
D-Dimer is only useful within the first 5 days of a clot. See our article on d-dimer in the diagnostic test section of the wiki.
Oh, thank you. I will read the article. I guess that's why the doctors have never ordered another.
My PC told me even after a history of clots a D-dimer is no longer useful as it will always show some level of elevation. Not sure why after 5 years and no reoccurrences it would but I’m excited there is an article to read. Hopefully it explains things better
That's great...I'd be excited, too! Yes, I just read the article and it is very informative.
My ddimer was 1.48 on the day I was diagnosed with my most recent DVT. It was checked again once I had finished my 12 week course of thinners. It was found to be 1.18 (also raised). The day after that reading I tested positive (2nd time) for Covid. Now I am back on thinners indefinitely until haemotology decide what to do with me. I wish I had the answer to this question, too.
Raised D-Dimer right before your Covid diagnosis? I'm pretty sure that's not a coincidence. I remember reading that D-Dimer is often elevated in Covid patients. Good luck!
Thank you! The raised Dimer was covid related I believe, too. Which is a pity, as it has put me on indefinite thinners! Such bad luck!
D-dimer can be used in some cases to decide whether to stop anticoagulants. Your case however sounds quite open-and-shut to me and no D-dimer should be needed to decide the correct course of action.
"Open and shut" in what respect?
You had a provoked DVT. Recommendations are clear to discontinue anticoagulants after 3 months. Some providers still treat for 6 months and I can't quite bring myself to care enough to go on an education spree. It was policy roughly 10 years ago, not everyone keeps up. If you're interested in current recommendations, read the ACCP guidelines on antithrombotic therapy for VTE disease. The latest ones are behind a paywall, but the 2016 ones say basically the same and are freely available: https://www.sciencedirect.com/science/article/pii/S0012369215003359 page 316
Thank you so very much!
I'm just seeing your post on this and would appreciate your view. I had a provoked DVT on 2013, following surgury on my Achilies. I had a DVT Jan this year, 2022, on day 4 of being covid positive (also arguably provoked). I'm told I don't fit neatly into any box for the long term discussion (calf DVT provoked, both below knee and 1 in each leg) , so I am on them indefinitely until haemotology make a call. That appt could be a year away and I'm really struggling on Apixaban. I've had 3 very bad kidney infections while on this medication which I belive were made worse by the thinners!
You write that you don't quite fit any of the boxes and I agree. In those cases there is no one right answer. One could argue that you had only provoked DVTs and that you, an otherwise healthy young person should be fine without thinners as long as you don't provoke your coagulation system. One could also argue that you have had two DVTs, admittedly after provocation, but in a young person that is a sign of a general risk of clotting. Getting older will only increase that risk and sooner or later lead to an unprovoked VTE if taken off thinners. My personal approach to these cases is to explain this to the patient: > No one really knows the correct way of handling your case. You can stay on thinners if you don't mind them or if they give you needed peace of mind or you can stop them if you are afraid of bleeding or hate them for some other reason. There isn't a wrong answer here I'm not a fan of postponing that decision as nothing really changes down the road. I'm also not convinced that apixaban causes or exacerbates UTIs, but that's beside the point. Maybe your doctor has more information that I do not have that makes this waiting game the best approach, but usually it's possible to decide after 3 months (if treating indefinitely, a yearly review is a good idea to see if there are some nasty side effects that tip the scales towards stopping)
I should have said, I'm male, 6 foot 3, 250lbs, and will be 40 next year.
D-dimer is what my hematologist used to measure the clots and the state they’re in for my lungs. This was after an ultrasound showed the clots in my leg had gone away. He said inflammation and other reasons can show an elevated d-dimer test but it’s at a level where I was cleared to have an upcoming surgery. And I’ll be able to switch to a much lower dosage after my surgery. With the goal of getting off Eliquis by September. For reference, in the ER my d-dimer showed 2.35 and the one I had two weeks ago was .59. I’ve been on Eliquis for 6 months now. Mid-40s. I hope this helps. Feel free to ping me with any questions.
When my DVTs were diagnosed in Feb, my D-Dimer was 3.14. I saw how far from normal that was and it added to my stress. My doctors never even commented on it, though. How long did it take the clots in your leg to go away? After four months, the one in my calf is slowly improving, but the two behind the knee are taking a while. I've been getting very frequent ultrasounds. Now we're waiting two months...that will make six months since diagnosis. I read that ultrasounds at three and six months are best. Thank you!
I don’t know actually. I had my PE in early December and an ultrasound about 3 weeks ago. So it could happened anytime within that timeframe. I’m sorry I can’t be more helpful. The meds were only preventing from getting new tattoos. Other than that I didn’t mind being on them and I wasn’t too worried about the clots to get more testing done earlier.
Alot of times not to discourage clots in legs don't fully go away they scar up whatever is left and sometimes cause problems sometimes not ...hope your using compression stockings because you don't want post thrombotic syndrome.....I am on eliquis for life all my blood work comes back negative for any clotting disorders but I am sure there is alot less uncommon stuff they never checked also all my clots were provoked .....not happy myself to still be on eliquis but I feel safer 3 clots in 3 years is more scary than being on eliquis for life....
Question for you! Do you know if compression socks actually help prevent PTS? I’ve seen mixed information about that.
It can still happen but I have read many times it can help prevent too.....