D-dimer level significance for deep vein thrombosis screening in the third trimester: a retrospective study

Abstract Background Venous thromboembolism often develops after surgery and childbirth, resulting in death in some cases. Although early deep vein thrombosis (DVT) detection can predict pulmonary thromboembolism, there is no early screening method for DVT in pregnant women. Lack of consensus regarding significance or setting and cut-off value interpretation of D-dimer levels further impedes venous thromboembolism screening in pregnant women. This study aimed to examine the utility of third-trimester serum D-dimer levels as a screening test for DVT during pregnancy and to determine the frequency of asymptomatic DVT using lower-limb compression ultrasonography. Methods This single-center retrospective study included 497 pregnant women who underwent elective cesarean section at term in our hospital between January 2013 and December 2019. Serum D-dimer levels were preoperatively measured at 32–37 weeks’ gestation. The presence or absence of DVT in patients with serum D-dimer levels ≥ 3.0 µg/ml, the cut-off value, was examined using compression ultrasonography. In all patients, the presence or absence of clinical venous thrombosis (symptoms such as lower-limb pain, swelling, and heat sensation) was examined within 4 postoperative weeks. The Royal College of Obstetricians and Gynecologists Guideline 2015 was referred to determine risk factors for the onset of venous thrombosis during pregnancy. Among those, we examined the risk factors for DVT that result in high D-dimer levels during pregnancy. Results The median age and body mass index were 35 (20–47) years and 21.2 (16.4–41.1) kg/m2, respectively. Further, the median gestational age and D-dimer levels were 37 weeks and 2.1 (0.2–16.0) µg/ml, respectively. Compression ultrasonography was performed on 135 (26.5%) patients with a D-dimer level ≥ 3.0 µg/ml, with none of the patients showing DVT. All patients were followed up for 4 postoperative weeks, with none presenting with venous thromboembolism. Multivariate analysis showed that hypertensive disorders of pregnancy are an independent risk factor for venous thromboembolism that causes high D-dimer levels (odds ratio: 2.48, 95% confidence interval: 1.05–6.50, P = 0.04). Conclusion There may be low utility in screening for DVT using D-dimer levels in the third trimester. Further, prepartum asymptomatic DVT has a low frequency, indicating the low utility of compression ultrasonography. Trial registration Institutional Review Board of Tottori University Hospital (IRB no. 20A149).

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D-Dimer Level Significance for Deep Vein Thrombosis Screening in The Third Trimester : A Retrospective Study

10.21203/rs.3.rs-753804/v1 ◽

2021 ◽

Author(s):

Keisuke Miyamoto ◽

Hiroaki Komatsu ◽

Masayo Okawa ◽

Yuki Iida ◽

Daiken Osaku ◽

...

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Lower Limb ◽

Third Trimester ◽

Vein Thrombosis ◽

The Third ◽

Deep Vein ◽

D Dimer ◽

Compression Ultrasonography

Abstract BackgroundVenous thromboembolism often develops after surgery and childbirth, resulting in death in some cases. Although early deep vein thrombosis (DVT) detection can predict pulmonary thromboembolism, there is no early screening method for DVT in pregnant women. Lack of consensus regarding significance or setting and cut-off value interpretation of D-dimer levels further impedes venous thromboembolism screening in pregnant women.This study aimed to examine the utility of third-trimester serum D-dimer levels for screening test for DVT during pregnancy.to determine the frequency of asymptomatic DVT using lower-limb compression ultrasonography.MethodsThis single-center retrospective study included 497 pregnant women who underwent elective cesarean section at term in our hospital between January 2013 and December 2019. Serum D-dimer levels were preoperatively measured at 32–37 gestation weeks. The presence or absence of DVT in patients with serum D-dimer levels ≥ 3.0 µg/ml, the cut-off value, was examined using compression ultrasonography. In all patients, the presence or absence of clinical venous thrombosis (symptoms such as lower-limb pain, swelling, and heat sensation) was examined within 4 postoperative weeks.The Royal College of Obstetricians and Gynecologists Guideline 2015 was referred to determine risk factors for the onset of venous thrombosis during pregnancy. Among those, we examined the risk factors for DVT that result in high D-dimer levels during pregnancy.ResultsThe median age and body mass index were 35 (20–47) years and 21.2 (16.4–41.1) kg/m2, respectively. Further, the median gestational age and D-dimer levels were 37 weeks and 2.1 (0.2–16.0) µg/ml, respectively. Compression ultrasonography was performed on 135 (26.5%) patients with a D-dimer level ≥3.0 µg/ml, with none of the patients showing DVT. All patients were followed up for 4 postoperative weeks, with none presenting with venous thromboembolism. Multivariate analysis showed that hypertensive disorders of pregnancy is an independent risk factor for venous thromboembolism that causes high D-dimer levels (odds ratio: 2.48, 95% confidence interval: 1.05–6.50, P=0.04).ConclusionThere may be low utility in screening for DVT using D-dimer levels in the third trimester. Further, prepartum asymptomatic DVT has a low frequency, indicating the low utility of compression ultrasonography.Trial registrationInstitutional Review Board of Tottori University Hospital (IRB no. 20A149).

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Venous Thromboembolism

10.2310/fm.1102 ◽

2020 ◽

Author(s):

Samuel Z. Goldhaber

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Antithrombotic Agents ◽

Vein Thrombosis ◽

Recurrent Venous Thrombosis ◽

Deep Vein ◽

D Dimer ◽

In Pregnancy

Venous thromboembolism, which involves venous thrombosis and pulmonary embolism, is a leading cause of morbidity and mortality in hospitalized patients and is being seen with increasing frequency in outpatients. This chapter discusses the risk factors, etiology, classification, pathophysiology, natural history, prognosis, diagnosis (including venous thrombosis, recurrent venous thrombosis, and pulmonary embolism), prophylaxis, and treatment of venous thromboembolism (including the pharmacology of antithrombotic agents), as well as venous thromboembolism in pregnancy and miscellaneous thromboembolic disorders (including thrombosis of unusual sites). This review contains 8 figures, 16 tables, and 79 references. Keywords: Venous thromboembolism, pulmonary embolism, deep vein thrombosis, embolectomy, thrombolysis, hypercoagulability, duplex ultrasonography, D-dimer, anticoagulation

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Factors affecting the recurrence in patients with venous thromboembolism: A retrospective cohort study

Turkish Journal of Thoracic and Cardiovascular Surgery ◽

10.5606/tgkdc.dergisi.2021.20679 ◽

2021 ◽

Vol 29 (3) ◽

pp. 384-390

Author(s):

Yasemin Ateş ◽

Züleyha Bingöl ◽

Gülfer Okumuş ◽

Orhan Arseven

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Venous Thromboembolism ◽

Pulmonary Thromboembolism ◽

First Year ◽

Factors Affecting ◽

Vein Thrombosis ◽

Hereditary Risk ◽

Deep Vein ◽

D Dimer

Background: The aim of the study was to evaluate the frequency of recurrence and the risk factors for recurrence in patients who were diagnosed with venous thromboembolism. Methods: Between January 2005 and January 2015, a total of 412 venous thromboembolism patients (164 males, 248 females; mean age: 53.5±16.6 years; range: 19 to 95 years) were retrospectively analyzed. The demographics, underlying risk factors, comorbidities, imaging findings, and treatment data of the patients were recorded. Results: At least one transient/permanent risk factor was found in 341 (82.7%) of the index events, and the other 71 (17.2%) were idiopathic. Recurrence developed in 76 (18.4%) of the patients. The duration of the treatment in the first event was significantly longer in recurrent cases (p=0.007). The recurrence rate in patients diagnosed with only deep vein thrombosis or patients diagnosed with pulmonary thromboembolism + deep vein thrombosis was significantly higher than the patients diagnosed with only pulmonary thromboembolism (24% vs. 14.2%, respectively; p=0.007). The rate of idiopathic venous thromboembolism was higher in recurrent cases than in non-recurrent cases (26.3% vs. 15.2%, respectively; p=0.028). At the end of the first year, the mean D-dimer levels were higher in recurrent cases (p=0.034). Hereditary risk factors were also higher in recurrent cases (39.5% vs. 19.3%, respectively; p=0.031). There was no significant correlation between recurrence and mortality. Conclusion: The presence of deep vein thrombosis, idiopathic events, high D-dimer levels at the end of the first year and hereditary risk factors seem to be associated with recurrence.

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Venous Thromboembolism

10.2310/7900.1102 ◽

2020 ◽

Author(s):

Samuel Z. Goldhaber

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Antithrombotic Agents ◽

Vein Thrombosis ◽

Recurrent Venous Thrombosis ◽

Deep Vein ◽

D Dimer ◽

In Pregnancy

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Venous Thromboembolism

10.2310/neuro.1102 ◽

2020 ◽

Author(s):

Samuel Z. Goldhaber

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Antithrombotic Agents ◽

Vein Thrombosis ◽

Recurrent Venous Thrombosis ◽

Deep Vein ◽

D Dimer ◽

In Pregnancy

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Venous Thromboembolism

10.2310/tywc.1102 ◽

2020 ◽

Author(s):

Samuel Z. Goldhaber

Keyword(s):

Risk Factors ◽

Pulmonary Embolism ◽

Venous Thromboembolism ◽

Venous Thrombosis ◽

Antithrombotic Agents ◽

Vein Thrombosis ◽

Recurrent Venous Thrombosis ◽

Deep Vein ◽

D Dimer ◽

In Pregnancy

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Analysis of risk factors for lower limb deep vein thrombosis in patients after Lumbar Fusion Surgery

Pakistan Journal of Medical Sciences ◽

10.12669/pjms.37.1.3041 ◽

2020 ◽

Vol 37 (1) ◽

Author(s):

Qiang Li ◽

Zongxue Yu ◽

Xiao Chen ◽

Wenli Zhang

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Lower Limb ◽

Lumbar Fusion ◽

Fusion Surgery ◽

Vein Thrombosis ◽

Prophylactic Measures ◽

Deep Vein ◽

Limb Deep Vein Thrombosis ◽

D Dimer

Objective: To identify the risk factors of deep vein thrombosis (DVT) of lower limb in patients undergoing lumbar fusion surgeries, to provide a better understanding of DVT and take prophylactic measures. Methods: This study was carried out in our hospital between January 2016 and February 2020, patients undergoing lumbar fusion surgeries were included and divided into DVT group and non-DVT group, and the medical data including basic demographics, clinical characteristics, operative data, and routine biochemical parameters were collected and analyzed. Results: In the current study, 390 cases were included, 48 cases were enrolled in DVT group and 342 in non-DVT group. The incidence of DVT was 12.3%. There were significant differences in age, hyperlipemia, hypertension, occupation type, D-dimer level, hospital stay, and postoperative exercises (p<0.05), but no significant differences in gender, smoking status, drinking status, coronary heart disease, diabetes mellitus, fused segments, and operation time (p>0.05) between the two groups. In multivariate analysis, age>50 years, hypertension, D-dimer>500ug/L were independent risk factors, while postoperative exercises were protective factor for DVT. Conclusion: Those patients undergoing lumbar fusion surgeries should take more prophylactic measures including postoperative exercises if they were elderly, or hypertensive, or have high D-dimer level, in order to decrease the incidence of DVT. doi: https://doi.org/10.12669/pjms.37.1.3041 How to cite this:Li Q, Yu Z, Chen X, Zhang W. Analysis of risk factors for lower limb deep vein thrombosis in patients after Lumbar Fusion Surgery. Pak J Med Sci. 2021;37(1):239-243. doi: https://doi.org/10.12669/pjms.37.1.3041 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Prevention of Venous Thromboembolism in 2020 and Beyond

Journal of Clinical Medicine ◽

10.3390/jcm9082467 ◽

2020 ◽

Vol 9 (8) ◽

pp. 2467

Author(s):

Matthew Nicholson ◽

Noel Chan ◽

Vinai Bhagirath ◽

Jeffrey Ginsberg

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

Genetic Risk ◽

Current Approach ◽

Common Cause ◽

Vein Thrombosis ◽

The Third ◽

Hormonal Therapies ◽

Deep Vein ◽

Vascular Mortality

Venous thromboembolism (VTE) is the third most common cause of vascular mortality worldwide and comprises deep-vein thrombosis (DVT) and pulmonary embolism (PE). In this review, we discuss how an understanding of VTE epidemiology and the results of thromboprophylaxis trials have shaped the current approach to VTE prevention. We will discuss modern thromboprophylaxis as it pertains to genetic risk factors, exogenous hormonal therapies, pregnancy, surgery, medical hospitalization, cancer, and what is known thus far about VTE in COVID-19 infection.

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PREVENTION AND TREATMENT OF VENOUS THROMBOEMBOLISM IN HIGH RISK SITUATIONS IN PREGNANCY

Fetal and Maternal Medicine Review ◽

10.1017/s0965539504001391 ◽

2005 ◽

Vol 16 (1) ◽

pp. 51-70 ◽

Cited By ~ 2

Author(s):

ANNE G McLEOD ◽

CAMERON ELLIS

Keyword(s):

Risk Factors ◽

Venous Thromboembolism ◽

High Risk ◽

Pregnant Women ◽

Signs And Symptoms ◽

Multiple Gestation ◽

Vein Thrombosis ◽

Low Threshold ◽

Deep Vein ◽

In Pregnancy

Venous thromboembolism (VTE) is a leading cause of maternal mortality in the western developed world. VTE may present as deep vein thrombosis (DVT) or pulmonary embolism (PE) but if untreated can result in fatal PE. Although fatal PE is clearly the most significant consequence of VTE in pregnancy, DVT also often leads to morbidity related to the development of post-thrombotic syndrome (PTS). Pregnancy is an independent risk factor for VTE and the risk of VTE is 4–10 fold higher in pregnant women than in non-pregnant women of similar age. The puerperium represents a time of even higher risk. It is clear that many additional high-risk situations in pregnancy lower the threshold for thrombosis and warrant measures to prevent VTE and its complications. Risk factors for pregnancy-related VTE may be inherited or acquired. Acquired risk factors may be specifically related to the pregnancy or may have developed prior to pregnancy. Well-documented risk factors for pregnancy-related VTE include delivery by Caesarean section, previous VTE, and inherited or acquired thrombophilia. Other risk factors that have been identified include obesity, multiparity, multiple gestation, pre-eclampsia and medical conditions, such as sickle cell disease, that predispose to VTE. Our ability to diagnose VTE overall is poor as presenting signs and symptoms are extremely varied and unreliable. This is further complicated in pregnancy where signs and symptoms suggestive of VTE are common and invasive testing is more complicated. It is essential that physicians be vigilant in monitoring patients for the development of VTE and maintain a low threshold for considering thromboprophylaxis. Guidelines have recently been published by several medical societies to help with these difficult decisions. In this review the risk factors for the development of VTE in pregnancy will be discussed and guidelines for risk assessment presented. Management of patients who develop VTE in pregnancy is also outlined.

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Study on the Risk Factors of Preoperative Deep Vein Thrombosis (DVT) in Patients With Lower Extremity Fracture

Clinical and Applied Thrombosis/Hemostasis ◽

10.1177/10760296211002900 ◽

2021 ◽

Vol 27 ◽

pp. 107602962110029

Author(s):

Wenjie Chang ◽

Bin Wang ◽

Qiwei Li ◽

Yongkui Zhang ◽

Wenpeng Xie

Keyword(s):

Risk Factors ◽

Deep Vein Thrombosis ◽

Lower Extremity ◽

Color Doppler ◽

Fracture Site ◽

Vein Thrombosis ◽

Lower Extremity Fracture ◽

Extremity Fracture ◽

Deep Vein ◽

D Dimer

Objective: The objective of this work is to discuss and analyze the related factors of lower extremity fracture complicated by preoperative deep vein thrombosis (DVT). Methods: A total of 11,891 patients with closed fractures of lower extremities were selected. By analyzing each patient’s gender, age, presence or absence of diabetes and hypertension, preoperative plasma D-dimer level, and color Doppler ultrasound of the lower extremity vein, the pertinent factors of the patients with lower extremity fractures complicated by preoperative DVT were analyzed. Results: A total of 578 with preoperative DVT were detected, displaying a total incidence of 4.86%. All patients were categorized into either the DVT group or non-DVT group. The results demonstrate that there were statistically significant differences between the 2 groups in age, the presence of diabetes and hypertension, the fracture site, and the preoperative plasma D-dimer level ( P < 0.05). Logistic multivariate analysis revealed that age, the presence of diabetes, and the preoperative plasma D-dimer level of patients were independent risk factors for lower extremity fracture complicated by DVT. Conclusion: Age, the presence of diabetes, the fracture site, and increased D-dimer levels were found to be potential risk factors and indicators for preoperative DVT in patients with lower extremity fractures. In addition, the preoperative plasma D-dimer level has certain guiding significance for the prediction of venous thrombosis after lower extremity fracture, which is conducive to the early prediction and diagnosis of DVT, but it often must be followed with good clinic acumen and examinations.

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