Dynamics of D‐dimer in non‐small cell lung cancer patients receiving radical surgery and its association with postoperative venous thromboembolism

Abstract

Background Venous thromboembolism (VTE) occurs at a high rate after lung cancer surgery and can be attributed to various clinical risk factors. Here, we aimed to determine whether early detection of perioperative D‐dimer and risk‐stratified cutoff values would improve the diagnostic efficacy of VTE. Methods In this case‐control study, D‐dimer results were acquired from 171 non‐small cell lung cancer (NSCLC) patients preoperatively and at the first, third, and fifth day after surgery. VTE was confirmed by Doppler ultrasonography and computer tomography pulmonary angiography (CTPA). Repeated measures ANOVA was used to analyze how D‐dimer changed with time and the effects of risk factors on D‐dimer levels. We then compared sensitivity, specificity and negative predictive value, using both adjusted and unadjusted cutoff values. Results VTE occurred in 23 patients (13.5%) of the study population. D‐dimer levels increased unsustainably after lung cancer surgery (P < 0.001) due to a trough on the third day, and patients who had undergone thoracotomy (P < 0.001) and those at a more advanced tumor stage (P = 0.037) had higher D‐dimer levels. Area under the curve of D‐dimer was greatest on the third day (0.762 [P < 0.001, 95% CI: 0.643–0.882]). Applying stratified cutoff values improved the specificity in the video‐assisted thoracoscopy surgery (VATS) (P = 0.004) and thoracotomy groups (P < 0.001). Conclusions D‐dimer levels elevated with fluctuation in NSCLC patients after surgery. Surgical options and tumor stages had an impact on D‐dimer levels. With regard to VTE diagnosis, stratified cutoff values by these two factors showed better accuracy compared with a collective one.. Key points Significant findings of the study The changing pattern of perioperative D‐dimer levels in NSCLC patients who received surgical therapy in a major teaching hospital in Beijing, China was revealed. What this study adds Risk‐stratified D‐dimer cutoff values adjusted to surgical methods and disease stages would benefit the exclusion of postoperative venous thromboembolism.

The Impact of D-Dimer on Postoperative Deep Vein Thrombosis in Patients with Thoracolumbar Fracture Caused by High-Energy Injuries

“…Although D-dimer is affected by many factors, it is still considered as a most powerful indicator of venous thromboembolic events. 23 , 24 Owings et al 25 sampled the plasma of severely injured patients for D-dimer assay at hours 8, 16, 24, and 48; and at days 3, 4, 5, and 6. they found before 48 h after injury, the vast majority of patients without thromboembolism had positive D-dimer assays, and D-dimer levels might be very low within 48 h of injury. Our previous study found that in patients with thoracolumbar fractures caused by high-energy injuries, D-dimer at admission was a risk factor for DVT, but the AUC value was not very high.…”

“…When employing D-dimer, many studies have taken various measures to improve the diagnostic value of D-dimer. 23 , 31 , 32 Ke et al used a respective cut-off value of D-dimer in subgroups and elevated the diagnostic ability of D-dimer in lung cancer patients after surgery. 23 In the present study, we performed a separate ROC analysis in order to determine the cut-off value in subgroups.…”

“… 23 , 31 , 32 Ke et al used a respective cut-off value of D-dimer in subgroups and elevated the diagnostic ability of D-dimer in lung cancer patients after surgery. 23 In the present study, we performed a separate ROC analysis in order to determine the cut-off value in subgroups. But we showed the cut-off values were so close that the sensitivity, specificity and NPV does not change compared to the whole population.…”

Incidence of venous thromboembolism and hemorrhage in Chinese patients after pulmonary lobectomy: mechanical prophylaxis or mechanical prophylaxis combined with pharmacological prophylaxis: a randomized controlled trial

“…Adverse events concerning bleeding included major bleeding that required surgical or endoscopic hemostasis or blood transfusion, and minor bleeding that required either discontinuation of drug treatment or drug hemostasis. All results were evaluated on the first, third, and fifth days after surgery, because a previous study found that fluctuations in D-dimer levels were generally significant during the first five days after lung resection (20).…”

Validation of a modified Caprini risk assessment model in lung cancer patients undergoing surgery: Results of a multicenter cross‐sectional observational study

“…In this study, the adapted Caprini scores were calculated in the early days postoperatively to incorporate clinical variables that displayed instant changes after surgery, while detecting the emergence of new risk factors (e.g., confined to bed over 72 h). Among them, D-dimer concentration is the very one that increases constantly the following surgery in a short time, 46 which means that the derived scores can be different at different time points. However, Alexander et al 47 found that even thrombosis biomarkers profiles including D-dimer concentration changed over time, the accompanied dynamic thrombogenic risks were not significantly associated with reliably discriminatory predictability of VTE event within a short period of following time (in 30 days).…”