Predicting Perioperative Venous Thromboembolism in Japanese Gynecological Patients

Abstract

ObjectiveTo develop a convenient screening method that can predict perioperative venous thromboembolism (VTE) and identify patients at risk of fatal perioperative pulmonary embolism (PE).MethodsPatients hospitalized for gynecological abdominal surgery (n = 183) underwent hematology tests and multidetector computed tomography (MDCT) to detect VTE. All statistical analyses were carried out using the SPSS software program (PASWV19.0J)ResultsThe following risk factors for VTE were identified by univariate analysis: plasmin-alpha2-plasmin inhibitor complex (PIC), thrombin-antithrombin III complex (TAT), and prolonged immobility (all p<0.001); age, neoadjuvant chemotherapy (NAC), malignancy, hypertension, past history of VTE, and hormone therapy (all p<0.01); and hemoglobin, transverse tumor diameter, ovarian disease, and menopause (all p<0.05). Multivariate analysis using these factors revealed that PIC, age, and transverse tumor diameter were significant independent determinants of the risk of VTE. We then calculated the incidence rate of perioperative VTE using PIC and transverse tumor diameter in patient groups stratified by age. In patients aged≦40 years, PIC ≧1.3 µg/mL and a transverse tumor diameter ≧10 cm identified the high-risk group for VTE with an accuracy of 93.6%. For patients in their 50 s, PIC ≧1.3 µg/mL identified a high risk of VTE with an accuracy of 78.2%. In patients aged ≧60 years, a transverse tumor diameter ≧15 cm (irrespective of PIC) or PIC ≧1.3 µg/mL identified the high-risk group with an accuracy of 82.4%.ConclusionsWe propose new screening criteria for VTE risk that are based on PIC, transverse tumor diameter, and age. Our findings suggest the usefulness of these criteria for predicting the risk of perioperative VTE and for identifying patients with a high risk of fatal perioperative PE.

Predicting of Venous Thromboembolism for Patients Undergoing Gynecological Surgery

“…The symptomatic postoperative DVT incidence was consistent with the previous study. 17 We found that the DVT incidence is much higher than previous reports in patients with gynecological malignant tumor. 6 , 18 Aside from different design of study, the patient population contributes to the discrepancy.…”

Changes in Biomarkers of Coagulation, Fibrinolytic, and Endothelial Functions for Evaluating the Predisposition to Venous Thromboembolism in Patients With Hereditary Thrombophilia

“… 13 – 16 Plasmin-α2-plasmin inhibitor complex, an irreversible complex of plasmin and a2-plasmin inhibitor, is considered as a satisfactory indicator of an enhanced fibrinolytic state in vivo because it is almost undetectable in normal persons and expected to be more useful for the clinical assessment of VTE in patients with a high-risk perioperative VTE. 17 , 18 Besides, t-PAIC, the 1:1 covalent inactive complex of tPA and PAI-1, has been proposed as a marker of the fibrinolytic system in the diagnosis of acute myocardial infarction (MI), stroke, and VTE. 19 – 21 Moreover, regarded as a marker of endothelial lesion, sTM, the glycoprotein appears in human urine and plasma in a truncated form of TM without transmembrane and cytoplasmic domains, is involved in this panel as well.…”

Performance evaluation of thrombomodulin, thrombin‐antithrombin complex, plasmin‐α2‐antiplasmin complex, and t‐PA: PAI‐1 complex

“…Lower PAP levels are associated with subsequent coronary events in patients with a history of MI . A previous study demonstrated that PAP is useful for predicting the risk of perioperative VTE and for identifying patients with a high risk of fatal perioperative PE . tPAI‐C is a complex of t‐PA with its type 1 inhibitor (PAI‐1) which has been reported to be of practical value in assessing risk of MI and VTE for both genders, especially for smokers or diabetes mellitus patients .…”

“…11 A previous study demonstrated that PAP is useful for predicting the risk of perioperative VTE and for identifying patients with a high risk of fatal perioperative PE. 12 tPAI-C is a complex of t-PA with its type 1 inhibitor (PAI-1) which has been reported to be of practical value in assessing risk of MI and VTE for both genders, especially for smokers or diabetes mellitus patients. 13,14 PAI-1 is synthesized from the endothelial cells as an active molecule, but it then spontaneously converts to a latent form, which can be partially reactivated in vitro.…”