Mp01-03 Prevalence of Preoperative Deep Vein Thrombosis and Predictive Value of D-dimer Assay in Patients Undergoing Radical Cystectomy for Urothelial Carcinoma
Year: 2016
Type: article
Study design: Observational Study
Abstract: INTRODUCTION AND OBJECTIVES: Patients undergoing radical cystectomy (RC) are at high preoperative risk for venous thromboembolic events (VTE) due to a combination of advanced age, pelvic malignancy, recent surgery (TURBT) and preoperative treatments.These factors lead RC patients to a rate of postoperative VTE higher than nearly any other non-orthopedic surgery.Given the significant morbidity and mortality associated with VTE, we sought to determine the prevalence of preoperative deep vein thrombosis (DVT) in patients undergoing RC for urothelial carcinoma.METHODS: We identified 52 asymptomatic patients scheduled for RC for urothelial carcinoma at our institution.Patients were screened for preoperative DVT with a combination of lower extremity ultrasound (LE US) and D-dimer assay within 2 weeks prior to RC. Patients with a prior history of VTE and those on systemic anticoagulation were excluded.Following RC, all patients were maintained on extended duration pharmacologic prophylaxis.RESULTS: We identified 4/52 patients (7.7%) with a preoperative asymptomatic DVT prior to RC.The majority of patients were male (43/52, 82.7%) with an average age of 68.5 years at the time of RC.Twenty-five patients (48.1%) underwent neoadjuvant chemotherapy prior to RC.The median D-dimer in all patients was 277 ng/ mL, 787 ng/mL in those with a DVT and 260 ng/mL in those without DVT.Using a positive cutoff of >250 ng/mL, the negative predictive value (NPV) of the D-dimer assay for preoperative DVT was 100%, and the positive predictive value (PPV) was 14.8%.Notably, no patient who screened negative for DVT prior to surgery experienced a VTE after RC.CONCLUSIONS: We observed a significant percentage of asymptomatic patients (7.7%) presenting with preoperative DVT prior to RC.Furthermore, screening for DVT with a serum D-dimer is sensitive, though poorly specific.Our study is limited by a small sample size, but indicates the realized risk of preoperative DVT in the setting of urothelial carcinoma of the bladder.
Source: The Journal of Urology
Language: English
Subfield: Internal Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2333100711