D-Dimer Level and the Risk for Thrombosis in Systemic Lupus Erythematosus

Patients who have systemic lupus erythematosus (SLE) and manifest antiphospholipid antibodies (APA) are at increased risk for thrombosis; however, it is difficult to predict who will clot. This study tested the hypothesis that peak D-dimer level measured routinely during follow-up identifies whether...

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Bibliographic Details
Published in:Clinical journal of the American Society of Nephrology 2008-11, Vol.3 (6), p.1628-1636
Main Authors: Wu, Haifeng, Birmingham, Daniel J, Rovin, Brad, Hackshaw, Kevin V, Haddad, Nabil, Haden, Douglas, Yu, Chack-Yung, Hebert, Lee A
Format: Article
Language:English
Subjects:
Adult
Antibodies, Antiphospholipid - blood
Biomarkers - blood
Clinical Nephrology
Female
Fibrin Fibrinogen Degradation Products - metabolism
Humans
Longitudinal Studies
Lupus Erythematosus, Systemic - blood
Lupus Erythematosus, Systemic - complications
Lupus Erythematosus, Systemic - immunology
Male
Middle Aged
Predictive Value of Tests
Prospective Studies
Recurrence
Risk Assessment
Risk Factors
Thrombosis - blood
Thrombosis - etiology
Time Factors
Up-Regulation
Young Adult
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Summary:Patients who have systemic lupus erythematosus (SLE) and manifest antiphospholipid antibodies (APA) are at increased risk for thrombosis; however, it is difficult to predict who will clot. This study tested the hypothesis that peak D-dimer level measured routinely during follow-up identifies whether a hypercoagulable state is developing and, therefore, the patient is at increased risk for thrombosis. One hundred consecutive patients who had SLE with recurrent activity (71% renal SLE) and were evaluated for or enrolled in the Ohio SLE Study were studied. D-dimer testing was done annually and usually at SLE flare or other serious illness. When D-dimer was elevated, evaluation for thrombosis (large vessel, small vessel, or Libman-Sacks) was undertaken. Mean follow-up was 37.5 +/- 15 SD months. Of those with peak D-dimer 2.0 microg/ml (n = 36), 42% thrombosed, 76% had APA. The most common causes of elevated D-dimer in the absence of demonstrable thrombosis were SLE flare and systemic infection. D-dimer levels were usually elevated for several months before thrombosis. Patients with SLE and normal D-dimer levels are at low risk for thrombosis, irrespective of APA status. Those with persistent unexplained elevated D-dimer levels, particularly when >2.0 microg/ml, are at high risk for thrombosis.
ISSN:1555-9041
1555-905X
DOI:10.2215/CJN.01480308