Background: Despite thromboprophylaxis, neurosurgical patients carry a high post-operative thromboembolic risk, due to various factors including paresis of lower extremity, immobilization, and hypercoagulability linked to neoplasia, trauma, steroids use. However, clinical signs and symptoms of DVT are often absent in these patients due to consciousness and/or neurological impairment.
Aims: To investigate whether elevated D-dimer levels may help diagnose post-surgery DVT in neurosurgical patients.
Methods: We conducted a retrospective observational study on all patients who underwent venous US for suspected DVT from elevated D-dimer levels after neurosurgery between January and August 2020. Patients were subdivided into 2 groups, DVT and non-DVT, and we compared the following parameters: clinical and demographic characteristics, type and duration of the surgical procedure, and D-dimer levels. Logistic regression analysis was used to ascertain any association between elevated D-dimer levels and risk of developing DVT in patients investigated between the 3rd -15th day after surgery. The ROC curve identified the cutoffs values for suspected DVT.
Results: Among 556 neurosurgical patients, 73 underwent post-surgery venous US for increased D-dimer levels and 35 had a DVT; between the 3rd -15th post-operative day, DVT occurred in 20/43 (46.5%) patients. We found no association between DVT and all variables considered, except D-dimer levels, which were higher in patients who developed DVT. Logistic regression analysis revealed OR 1.98 (CI 1.04-3.78, p 0.03) for each 1000 µg/L D-dimer increase. The ROC curve identified an optimal D-dimer cutoff 1334 µg/L (SEN 0.90, SPE 0.52, LR- 0.2) (OR 9.8, CI 1.8-5.7, p 0.007); 2200 µg/L D-dimer levels were associated with the best positive predictive value (SPE 0.87, PPV 77%, LR+ 3.8).
Conclusions: Elevated D-dimer levels were associated with increased risk of developing DVT after neurosurgery.
To cite this abstract in AMA style:Sartori MT, Bozzolin A, Camporese G, Ciccarino P, Boscaro F, Rizzoli A, Avruscio G, Fabris F. Elevated D-dimer Levels and DVT Following Neurosurgery [abstract]. Res Pract Thromb Haemost. 2021; 5 (Suppl 2). https://abstracts.isth.org/abstract/elevated-d-dimer-levels-and-dvt-following-neurosurgery/. Accessed November 29, 2021.
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