Efficacy of Coagulofibrinolytic Markers for Postoperative Prediction of Venous Thromboembolism in Colorectal Surgery Patients: A Retrospective Observational Study

Hironori Matsumoto; Kei Ishimaru; Satoshi Kikuchi; Satoshi Akita; Yuji Yamamoto; Motohira Yoshida; Shigehiro Koga; Hiroyuki Egi; Yuji Watanabe

doi:10.23922/jarc.2022-077

Efficacy of Coagulofibrinolytic Markers for Postoperative Prediction of Venous Thromboembolism in Colorectal Surgery Patients: A Retrospective Observational Study

J Anus Rectum Colon. 2023 Jul 25;7(3):140-149. doi: 10.23922/jarc.2022-077. eCollection 2023.

Authors

Hironori Matsumoto¹, Kei Ishimaru², Satoshi Kikuchi¹, Satoshi Akita², Yuji Yamamoto¹, Motohira Yoshida¹, Shigehiro Koga¹, Hiroyuki Egi¹, Yuji Watanabe¹

Affiliations

¹ Department of Gastrointestinal Surgery and Surgical Oncology, Graduate School of Medicine, Ehime University, Toon, Japan.
² Department of Minimally Invasive Gastroenterology, Graduate School of Medicine, Ehime University, Toon, Japan.

Abstract

Objectives: A low rate of the incidence of venous thromboembolism (VTE) after surgeries that are preoperatively classified as having high risk of VTE has been reported in recent years. We seek to identify the optimal cases to receive perioperative pharmacologic thromboprophylaxis. In this study, we evaluated the incidence rate of VTE among patients undergoing colorectal surgery who did not receive perioperative pharmacologic thromboprophylaxis, and the ability of coagulofibrinolytic markers to predict the postoperative development of VTE.

Methods: We retrospectively analyzed the rate of postoperative development of VTE in 70 patients undergoing elective colorectal surgery without perioperative pharmacologic thromboprophylaxis and the ability of coagulofibrinolytic markers to predict the development of VTE.

Results: The incidence of VTE was observed in 11 patients (15.7%); all cases were asymptomatic and distal-type deep vein thrombosis (DVT). Comparisons of time course changes in perioperative coagulofibrinolytic markers between patients with and without DVT revealed significant differences in soluble fibrin (SF), thrombin-antithrombin complex (TAT), fibrin/fibrinogen degradation product (FDP) and D-dimer. Dynamic postoperative physiological coagulofibrinolytic responses were shown, but all four markers at each postoperative point demonstrated moderate accuracy (median area under the curve [AUC]: 0.788, median sensitivity: 0.865, median specificity: 0.644) for predicting the development of DVT.

Conclusions: The incidence of postoperative VTE was low in patients with colorectal surgery even in those who did not receive perioperative pharmacologic thromboprophylaxis. SF, TAT, FDP and D-dimer were useful for predicting the development of DVT when we set cut-off values taking the physiological perioperative coagulofibrinolytic responses into consideration.

Keywords: D-dimer; deep vein thrombosis; fibrin/fibrinogen degradation product; soluble fibrin; thrombin-antithrombin complex.