Introduction/Background Postoperative venous thromboembolism (VTE) is the most important perioperative complication that worsens mortality. Preventive measures for postoperative VTE have been developed recently; however, postoperative pulmonary embolism (PE) still occurs. This might be caused by a preoperative deep venous thrombosis. Therefore, we consider that preoperative VTE screening is important to decrease the incidence of postoperative VTE.
Methodology We have been performing preoperative VTE screening using enhanced computed tomography (CT) based on D-dimer levels of >1.0 µg/ml for all patients with gynaecologic malignancies since 2009. We retrospectively examined the diagnostic accuracy of D-dimer level for VTE screening and determined the appropriate cutoff D-dimer level to predict VTE in 1042 patients with gynaecologic malignancies (147 with cervical cancer [CC], 463 with endometrial cancer [EC], and 432 with ovarian cancer [OC]) who underwent surgery at Chiba University Hospital between 2009 and 2017.
Results VTE was observed in 133 of 432 patients with D-dimer levels of >1.0 µg/ml and in 4 of 610 patients with D-dimer levels ≤1.0 µg/ml (sensitivity, 97.1%; specificity, 66.9%; positive predictive value, 30.1%; negative predictive value, 99.3%). On the basis of the receiver-operating characteristic curve, setting the cutoff D-dimer level to 1.2 µg/ml for EC and 1.5 µg/ml for OC increased the diagnostic accuracy.
Conclusion We revealed the high incidence of preoperative VTE, including PE in patients with EC and OC. Preoperative VTE screening for patients with gynaecologic malignancies using enhanced CT based on D-dimer level might be a useful strategy for preventing postoperative mortality due to VTE.
Disclosure Nothing to disclose.
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