Subject(s)
Blood Coagulation/drug effects , Health Services Needs and Demand , Hemorrhage/prevention & control , Medication Therapy Management , Thromboembolism/drug therapy , Warfarin , Administration, Oral , Aged , Anticoagulants/administration & dosage , Anticoagulants/adverse effects , Anticoagulants/pharmacokinetics , Dose-Response Relationship, Drug , Female , Health Services Needs and Demand/organization & administration , Health Services Needs and Demand/standards , Hemorrhage/chemically induced , Humans , International Normalized Ratio , Male , Middle Aged , Patient Education as Topic , Secondary Prevention/organization & administration , Secondary Prevention/standards , Thromboembolism/metabolism , Thromboembolism/physiopathology , Warfarin/administration & dosage , Warfarin/adverse effects , Warfarin/pharmacokineticsABSTRACT
D-dimer as an activation marker of coagulation and fibrinolysis is a recognized diagnostic criterion of deep vein thrombosis, pulmonary thromboembolism, and disseminated intravascular coagulation. In recent years, this laboratory test has been most frequently used for other purposes: to detect the activation of coagulation, to predict the course of diseases, and to determine the duration of anticoagulant therapy. Our investigation examined 1514 D-dimer measurements in 1370 outpatients without acute abnormalities, including 72 patients receiving warfarin and 32 patients after myocardial revascularization. 36.1% of cases were found to have values of more than 0.5 mkg/ml. Adequate anticoagulant therapy (INR 2-3) caused a reduction in the level of D-dimer that is an important additional laboratory test for the evaluation of antithrombotic defense. Further investigations are needed to determine cutoff values for various clinical situations.