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

Taiichiro Miyake; Hiroaki Yanagimoto; Daisuke Tsugawa; Masayuki Akita; Riki Asakura; Keisuke Arai; Toshihiko Yoshida; Shinichi So; Jun Ishida; Takeshi Urade; Yoshihide Nanno; Kenji Fukushima; Hidetoshi Gon; Shohei Komatsu; Sadaki Asari; Hirochika Toyama; Masahiro Kido; Tetsuo Ajiki; Takumi Fukumoto

doi:10.12998/wjcc.v12.i2.276

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

World J Clin Cases. 2024 Jan 16;12(2):276-284. doi: 10.12998/wjcc.v12.i2.276.

Authors

Taiichiro Miyake¹, Hiroaki Yanagimoto², Daisuke Tsugawa¹, Masayuki Akita¹, Riki Asakura¹, Keisuke Arai¹, Toshihiko Yoshida¹, Shinichi So¹, Jun Ishida¹, Takeshi Urade¹, Yoshihide Nanno¹, Kenji Fukushima¹, Hidetoshi Gon¹, Shohei Komatsu¹, Sadaki Asari¹, Hirochika Toyama¹, Masahiro Kido¹, Tetsuo Ajiki¹, Takumi Fukumoto¹

Affiliations

¹ Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan.
² Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan. yanagimh@med.kobe-u.ac.jp.

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