title: Predicting perioperative venous thromboembolism in Japanese gynecological patients.
abstract: OBJECTIVE
  To develop a convenient screening method that can predict perioperative venous thromboembolism (VTE) and identify patients at risk of fatal perioperative pulmonary embolism (PE).
  
  
  METHODS
  Patients 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).
  
  
  RESULTS
  The 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%.
  
  
  CONCLUSIONS
  We 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.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Specialized Clinical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Masae
authors.initials: M
authors.lastname: Ikeda
authors.affiliation: Department of Obstetrics and Gynecology, Division of Specialized Clinical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Hidetoshi
authors.initials: H
authors.lastname: Kan-no
authors.affiliation: Department of Obstetrics and Gynecology, Division of Specialized Clinical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Hayashi
authors.affiliation: Department of Obstetrics and Gynecology, Division of Specialized Clinical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Hitomi
authors.initials: H
authors.lastname: Tsukada
authors.affiliation: Department of Obstetrics and Gynecology, Division of Specialized Clinical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Masako
authors.initials: M
authors.lastname: Shida
authors.affiliation: Department of Obstetrics and Gynecology, Division of Specialized Clinical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Hirasawa
authors.affiliation: Department of Obstetrics and Gynecology, Division of Specialized Clinical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Toshinari
authors.initials: T
authors.lastname: Muramatsu
authors.affiliation: Department of Medical Informatics, Division of Basic Medical Science and Molecular Medicine, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Ogushi
authors.affiliation: Department of Obstetrics and Gynecology, Division of Specialized Clinical Science, Tokai University School of Medicine, Isehara, Kanagawa, Japan.
authors.forename: Mikio
authors.initials: M
authors.lastname: Mikami
mesh_terms: D000328:Adult; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007564:Japan; D008875:Middle Aged; D059035:Perioperative Period; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000453:epidemiology*