Guided duration of anticoagulation after unprovoked venous thromboembolism using D-dimer testing.

Venous thromboembolism (VTE) is a frequent, multifactorial and potentially life-threatening disease [1–3]. When VTE occurs in the absence of any major risk factor (i.e. surgery, prolonged immobilisation or trauma of the lower limb), the risk of recurrent VTE is high (i.e. about 10% at 1 year and 30% at 5 years) after anticoagulation therapy is stopped, and current guidelines recommended indefinite anticoagulation once a first episode of unprovoked VTE has occurred [1–8]. However, only one-third of these patients will benefit from indefinite anticoagulation whereas, in the others, the risk of anticoagulant therapy-related bleeding probably outweighs any risk of recurrent VTE after stopping anticoagulation therapy. Therefore, the determination of the individual risk of recurrent VTE among patients with unprovoked VTE remains a major issue. In this setting, PALARETI et al. [9] report, in this issue of the European Respiratory Journal, the results of a subanalysis of the “DULCIS” study, a large prospective cohort of 1010 patients with unprovoked VTE [10]; the main aim was to evaluate the accuracy of serial D-dimer assessment to predict the risk of recurrent VTE according to whether patients had unprovoked pulmonary embolism (PE) or deep vein thrombosis (DVT) [9].