Natsumeda M, et al. - Researchers designed a prospective study to elucidate incidence and predictors of deep venous thrombosis (DVT) in patients undergoing craniotomies. They observed frequent DVT in patients before and after undergoing craniotomies. By checking D-dimer levels, preoperative screening for DVT was recommended for patients with decreased performance status. Raised D-dimer levels on postoperative days (POD) 7 compared to POD3, and D-dimer levels above 2.65 μg/mL at POD7 were suggestive of DVT presence.

Methods

• Pre- and postoperative venous ultrasonography and/or contrast-enhanced spiral computed tomography for diagnosis of DVT were performed in 92 patients who underwent craniotomies.
• DVT occurrence was observed as the primary endpoint.
• An analysis of serial levels of serum D-dimer, soluble fibrin, and thrombin-antithrombin complex (TAT) was performed.

Results

• DVT was identified in 24 of 92 patients (26.1%).
• Of these, 10 (41.7%) patients were diagnosed preoperatively.
• Age, incidence of decreased performance status and leg paresis, levels of D-dimer, soluble fibrin, and TAT were markedly higher in patients with preoperative DVT.
• Patients with postoperative DVT demonstrated significantly higher length of surgery, incidence of decreased postoperative performance status, levels of D-dimer on postoperative days (POD) 3, 7, and 14, and TAT on POD7.
• On POD7, patients with postoperative DVT showed higher D-dimer levels compared to POD3.
• Researchers suggested the utility of the D-dimer cutoff of 2.65 μg/mL at POD7 to identify DVT with 85.7% sensitivity and 72.3% specificity.
• In this study, a cutoff of 5.25 at POD7 μg/mL yielded a specificity of 96.9%.
• Independent predictors for preoperative DVT included decreased performance status and elevated D-dimer.
• Independent predictors for postoperative DVT included prolonged operation time and elevated D-dimer on POD7.