Asymptomatic Venous Thromboembolism After Hepatobiliary–Pancreatic Surgery: Early Detection Using D‐dimer and Soluble Fibrin Monomer Complex Levels

Abstract

Abstract Aim The aim was to investigate the usefulness of a preemptive management strategy that includes monitoring serum D‐dimer (DD) and soluble fibrin monomer complex (SFMC) levels for early detection and treatment of venous thromboembolism (VTE) after hepatobiliary–pancreatic (HBP) surgery. Methods Overall, 678 patients who underwent HBP surgery between January 2010 and March 2020 were enrolled. Patients with increased postoperative serum DD or SFMC levels underwent contrast‐enhanced computed tomography, and those with VTE received anticoagulant agents. The VTE risk factors were investigated using multivariable analysis. Postoperative changes in DD and SFMC levels were verified, and their ability to identify VTE was evaluated using receiver operating characteristic (ROC) analysis. Results VTE developed in 83 patients (12.2%), and no symptomatic VTE or death due to VTE was observed. Multivariable analysis identified female sex (odds ratio [OR] 2.26; 95% confidence interval [CI] 1.41–3.60; P < .001) and surgery duration of ≥401 min (OR 2.07; 95% CI 1.27–3.35; P < .001) as independent risk factors for VTE. Maximum serum DD and SFMC levels in patients who developed VTE were significantly higher than those in patients without VTE (DD, 15.1 vs 8.9 μg/mL, P < .001; SFMC, 18.0 vs 10.2 μg/mL, P < .001, respectively). Both DD (n = 678) and the combination of DD and SFMC levels (n = 230) showed a good ability to detect VTE (area under the ROC curve, 0.804 and 0.761, respectively). Conclusion Our preemptive strategy of monitoring serum DD and SFMC levels enables early detection and treatment intervention of VTE after HBP surgery.

Keywords

• D‐dimer
• hepatobiliary–pancreatic surgery
• prophylactic anticoagulation
• soluble fibrin monomer complex
• venous thromboembolism