Background: Postoperative pharmacological thromboprophylaxis is well established practice. Dosing and duration depends on the type of surgery, body mass as well as patient-related risk factors. A growing tendency towards routine monitoring of D-dimers in order to discontinue postoperative thromboprophylaxis is being observed in our clinical practice.
Aims: To investigate the reasons for routine ordering D-dimer test and extended thromboprophylaxis with low molecular with heparin (LMWH) after hospitalization.
Methods: We investigated 57 adult outpatients with recent abdominal surgery. They received LMWH during and after hospitalization. D-dimer test was ordered at the end of hospitalization and every 7 days depending on the D-dimer (normal level <500ng/mL).
Results: The mean age of patients was 54 years and none of them had previous thromboembolic event, nor additional risk for venous thromboembolism. The mean time of hospitalization was 5 days. No postoperative complications were observed. At discharge, D-dimers were in the range from 1900 to 3800ng/mL. Thromboprophylaxis with enoxaparin was prescribed for 7 days. Subsequent D-dimers ranged from 1400 to 3100ng/mL in 47 patients who came for the second laboratory check and from 800 to 1700ng/mL in 32 patients who came for the third check. LMWH was continued in all of the patients for another 7 days, so they received LMWH at least two to three weeks post discharge. The criteria for ordering the D-dimer test and the targeted D-dimer level to stop the thromboprophylaxis remained uncertain.
Conclusions: It is well known that elevated levels of D-dimer may be seen in conditions such as surgery, trauma, inflammation, infection, etc. Therefore, there is no evidence-based need for routine ordering of the D-dimer test, nor for the extended LMWH thromoprophylaxis on regular basis after surgery in outpatient setting. It is imperative that every hospital should develop a cost-effective thromboprophylactic strategy according to the international and local guidelines.
To cite this abstract in AMA style:Makarovska Bojadjieva T, Velkova E, Dejanova Ilijevska V, Petkovic E, Ristovska E, Useini S, Grubovic R, Tashkovska M, Todorovski B. D-Dimer Test and Postoperative Thromboprophylaxis [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 1). https://abstracts.isth.org/abstract/d-dimer-test-and-postoperative-thromboprophylaxis/. Accessed September 24, 2021.
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