Utility of plasma D-dimer for diagnosis of venous thromboembolism after hepatectomy

Abstract

BACKGROUND

Venous thromboembolism (VTE) is a potentially fatal complication of hepatectomy. The use of postoperative prophylactic anticoagulation in patients who have undergone hepatectomy is controversial because of the risk of postoperative bleeding. Therefore, we hypothesized that monitoring plasma D-dimer could be useful in the early diagnosis of VTE after hepatectomy.

AIM

To evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of VTE after hepatectomy.

METHODS

The medical records of patients who underwent hepatectomy at our institution between January 2017 and December 2020 were retrospectively analyzed. Patients were divided into two groups according to whether or not they developed VTE after hepatectomy, as diagnosed by contrast-enhanced computed tomography and/or ultrasonography of the lower extremities. Clinicopathological factors, including demographic data and perioperative D-dimer values, were compared between the two groups. Receiver operating characteristic curve analysis was performed to determine the D-dimer cutoff value. Univariate and multivariate analyses were performed using logistic regression analysis to identify significant predictors.

RESULTS

In total, 234 patients who underwent hepatectomy were, of whom (5.6%) were diagnosed with VTE following hepatectomy. A comparison between the two groups showed significant differences in operative time (529 vs 403 min, P = 0.0274) and blood loss (530 vs 138 mL, P = 0.0067). The D-dimer levels on postoperative days (POD) 1, 3, 5, 7 were significantly higher in the VTE group than in the non-VTE group. In the multivariate analysis, intraoperative blood loss of > 275 mL [odds ratio (OR) = 5.32, 95% confidence interval (CI): 1.05-27.0, P = 0.044] and plasma D-dimer levels on POD 5 ≥ 21 μg/mL (OR = 10.1, 95%CI: 2.04-50.1, P = 0.0046) were independent risk factors for VTE after hepatectomy.

CONCLUSION

Monitoring of plasma D-dimer levels after hepatectomy is useful for early diagnosis of VTE and may avoid routine prophylactic anticoagulation in the postoperative period.

Keywords: Hepatectomy; Malignant tumor; Postoperative complication; D-dimer; Early diagnosis; Venous thromboembolism

Core Tip: This is the first retrospective study to evaluate the utility of monitoring plasma D-dimer levels in the early diagnosis of venous thromboembolism (VTE) after hepatectomy. Thirteen (5.6%) patients were diagnosed with VTE following hepatectomy and none of the patients required intensive care unit management (or oxygen administration) due to worsening respiratory status. The VTE group tended to have significantly elevated postoperative plasma D-dimer. Elevated D-dimer on postoperative day 5 and increased intraoperative blood loss were risk factors in the development of VTE after hepatectomy. Monitoring of plasma D-dimer levels after hepatectomy may allow early detection of asymptomatic VTE and may help avoid routine postoperative anticoagulation.