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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
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
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, Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe 650-0017, Hyogo, Japan
Author contributions: Miyake T and Yanagimoto H involved in the project development and data management; Miyake T, Yanagimoto H, Tsugawa D, Akita M, and Asakura R contributed to the data analysis and manuscript writing/editing; Arai K, Yoshida T, So S, Ishida J, Urade T, Nanno Y, Fukushima K, Gon H, Komatsu S, Asari S, Toyama H, Kido M, and Ajiki T provided clinical advice; Fukumoto T supervised the report.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Kobe University Graduate School of Medicine (Provided ID Number: B210306).
Informed consent statement: Informed consent was obtained from the opt-out principle. For full disclosure, the details of the study are published on the home page of Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Hiroaki Yanagimoto, MD, PhD, Professor, Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan. yanagimh@med.kobe-u.ac.jp
Received: November 6, 2023
Peer-review started: November 6, 2023
First decision: November 22, 2023
Revised: December 5, 2023
Accepted: December 25, 2023
Article in press: December 25, 2023
Published online: January 16, 2024
Processing time: 66 Days and 0.2 Hours
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.
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.
