title: Preoperative screening of thromboembolism using plasma D-dimer test and proximal vein compression ultrasonography in Japanese gynecologic patients.
abstract: BACKGROUND
  Venous thromboembolism (VTE) is a serious complication of surgery, including gynecologic surgery. The plasma D-dimer test and proximal/distal vein compression ultrasonography are frequently used as an easy, preoperative VTE screening method. However, targeted patients for these two examinations have not been established.
  
  
  METHODS
  We retrospectively reviewed 380 gynecologic surgical patients who underwent preoperative VTE screening including the plasma D-dimer test and proximal/distal vein compression ultrasonography from March 2014 to February 2015. All patients underwent laparotomy or laparoscopy. In patients with a high risk of pulmonary thromboembolism, compression ultrasonography was substituted by or combined with contrast-enhanced computed tomography. With regard to D-dimer level, patients were divided to three groups: D-dimer level ≤0.5 μg/mL (group A), D-dimer level between 0.6 and 0.9 μg/mL (group B), and D-dimer level ≥ 1.0 μg/mL (group C).
  
  
  RESULTS
  Twenty-seven cases had preoperatively detected VTE. Three patients in group B with benign disease were diagnosed with VTE before surgery. Among benign patients in group B, there was a significant difference in preoperative VTE occurrence between patients without risk factors (0/68 cases) and those with risk factors (3/54 cases). All 11 patients with benign disease having preoperative VTE had one or more risk factors.
  
  
  CONCLUSIONS
  Even in benign cases with low preoperative D-dimer levels (0.6-0.9 μg/mL), an imaging test should be added when the patient has one or more VTE risk factors.
authors.affiliation: Department of Obstetrics and Gynecology, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-shi, Chiba 270-1694, Japan.
authors.forename: Daisuke
authors.initials: D
authors.lastname: Shigemi
authors.affiliation: Department of Obstetrics and Gynecology, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-shi, Chiba 270-1694, Japan.
authors.forename: Tomohiko
authors.initials: T
authors.lastname: Matsuhashi
authors.affiliation: Department of Obstetrics and Gynecology, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-shi, Chiba 270-1694, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Yamada
authors.affiliation: Department of Obstetrics and Gynecology, Nippon Medical School, Chiba Hokusoh Hospital, 1715 Kamagari, Inzai-shi, Chiba 270-1694, Japan.
authors.forename: Seiryu
authors.initials: S
authors.lastname: Kamoi
authors.affiliation: Department of Obstetrics and Gynecology, Nippon Medical School Hospital, 1-5 Sendagi 1 chome, Bunkyo-ku, Tokyo 113-0022, Japan.
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Takeshita
keywords: D-dimer; Gynecologic surgery; Retrospective study; Ultrasonography; Venous thromboembolism