Search predictive factors of recurrence in venous thromboembolic disease associated with cancer after withdrawal of the anticoagulation. HISPALIS study

To determine biomarker9s predictive value in VTD recurrence in oncologic patients at different times during the follow-up after withdrawal anticoagulation. Methods: Prospective,observational,multicenter study.After removing treatment,a blood sample was taken in all patients at three different moments(basal,at 3weeks and 3months)for determination of D-dimer(DD),C-reactive protein(CRP),P-selectin(PS) and activity procoagulant phospholipids(PPL).Patients were followed up for 6months after suspension anticoagulant therapy.Outcomes were recurrences,deaths and reintroduction of anticoagulation. Results: 104 patients were included.All of them accepted anticoagulant treatment suspension.87patients completed 6months of follow up(median=7months,range=0-18)with a mean age of 63±13years and 53%were men.The most frequent types of cancer were colorectal cancer19.5%,breast17%,hematologic13.8% and lung10.3%.38%of patients had metastatic cancer.97%of patients had an ECOG0-1.Central Venous Catheter-Associated Thrombosis was 11%.7patients died(8%),one for recurrence of VTD.There were 10recurrences(11.5%):5were between 3weeks and 3months and another 5recurrences after 3months.Determinations with best AUC in relation to recurrences were made at 3weeks,and cutoff points were:DD1000mg/ml,RCP5,75mg/L and PS49,27ng/ml.The hazard ratios of these variables were: HR=4.98[(95%IC:1.28-19.32)p=0.020],HR=7.43[(95%IC:1.53-36.02)p=0.013],and HR=10[(95%IC:2.01-49.84)p=0.005],respectively. Conclusions: Determinations of D-dimer,CRP and P-selectin at 3weeks after anticoagulation suspension may be useful to decide the reintroduction of treatment at high risk of recurrences.