D-Dimer Levels Mostly Elevated on the Postoperative First Week

Yıl 2009, Cilt: 3 Sayı: 2, 91 - 96, 26.07.2009

Ayşegül Karalezli

Öz

Objective: D-dimer has become one of the frequently used parameters in the diagnosis of pulmonary thromboembolism as it is a rapidly resulted test. D-dimer, as it is a fibrin degradation product, can also elevate in trauma, postoperative period, some acute and chronic diseases beside pulmonary thromboembolism. In literature, there is not enough study about D-dimer elevation in postoperative period. The purpose of our study is to determine postoperative D-dimer increase and show in which days this increase occurs. Material and Methods: Electively operated 59 patients were included into this study. All patients over 40 years old were administered prophylaxis by low molecular weight heparin in preoperative and postoperative first days. We evaluated D-dimer levels of patients by using latex agglutination test on the first day of preoperative and postoperative 1st, 3rd, 7th and 15th days. Results: The dispersal of operated patients: Multinodular goiter (13), cholelithiasis (12), inguinal hernia (10), pilonidal sinus (6), incisional hernia (5), others (13). D-dimer levels were 0,186±0,344 mg/L preoperatively, 0,312±0,346 mg/L on postoperative 1st days, 0,307±0,410 mg/L 3rd day, 0,289±0,443 mg/L 7th day and 0,271±0,527 mg/L 15th day. D-dimer levels were found significantly higher on the 1st and 3rd days when compared to preoperative levels (p<0.001, p<0.001, respectively). Conclusion: As a result in the postoperative period D-dimer test is inadequate for the diagnosis of pulmonary embolism.

Anahtar Kelimeler

Venous thromboembolism; postoperative period; fibrin fragment D, fibrin fragment D, postoperative period;

Postoperatif Dönemde D-Dimer Seviyeleri

Öz

Amaç: D-dimer pulmoner tromboemboli tanısında en sık kullanılan ve oldukça hızlı sonuçlanan bir testtir. Fibrin yıkım ürünü olan D-dimer pulmoner tromboemboli dışında travma, postoperatif dönem, akut ve kronik bazı hastalıklarda da yükselmektedir. Literatürde postoperatif dönemde D-dimer yüksekliğiyle ilgili yeterli çalışma bulunmamaktadır. Bu çalışmanın amacı postoperatif D-dimer yüksekliğini ve hangi günlerde bu yüksekliğin ortaya çıktığını tespit etmektir.

Gereç ve Yöntemler: Çalışmaya elektif şartalarda öpere edilen 59 hasta alındı. Hastaların hepsi 40 yaşın üzerindeydi ve preoperatif ve postoperatif 1. günde düşük molekül ağırlıklı heparin profilaksisi uygulandı. Hastaların D-dimer düzeyleri preoperatif ve postoperatif 1, 3, 7 ve 15 günlerde latex aglü-tinasyon testi ile değerlendirildi.

Bulgular: Öpere hastaların dağılımı: Multinodüler guatr (13), kolelitiazis (12), inguinal herni (10), pilonoidal sinüs (6), insizyonel herni (5), diğerleri (13). D-dimer düzeyleri preoperatif 0,186±0,344 mg/L, postoperatif 1. günde 0.312 ± 0.346 mg/L, postoperatif 3. günde 0.307 ± 0.410 mg/L, postoperatif 7. günde 0.289 ± 0.443 mg/L and postoperatif 15. günde 0.271 ± 0.527 mg/L'di. Postoperatif D-dimer düzeyleri preoperatif düzeyle karşılaştırıldığında 1. ve 3. günlerde istatistiksel olarak anlamlı yüksek bulundu (p< 0.001, p< 0.001, sırasıyla).

Sonuç: Sonuç olarak postoperatif dönemde D-dimer yüksekliği tek başına pulmoner tromboemboli tanısını koymada yetersizdir.

Ayşegül KARALEZLİ, H. Canan HASANOĞLU, Recep AYDIN, Mükremin ER, Ebru Şengül ŞEREF PARLAK, Ahmet KUŞDEMİR,

Anahtar Kelimeler

Venöz tromboemboli, postoperatif dönem, D-dimer

Kaynakça

• 1. Johna S, Cemaj S, O'Callaghan T, Catalano R. Effect of tissue injury on D-dimer levels: a prospective study in trauma patients. Med Sci. Monit 2002;8:CR5-8.
• 2. Perrier A, Roy PM, Aujesky D, Chagnon I, Howarth N, Gourdier AL, et al. Diagnosing pulmonary embolism in outpatients with clinical assessment, D-dimer measurement, venous ultrasound, and helical computed tomography: a multi center management study. Am J Med 2004; 116:352-3.
• 3. Gingsbery JS, Wells PS, Brill-Edwards P, Donovan D, Panju A, van Beek EJ, et al. Application of a novel and rapid whole blood assay for D-dimer in patients with clinically suspected pulmonary embolism. Throm Haemost 1995;73:35-8.
• 4. Kelly J, Hunt BJ. A Clinical probability assessment and D-dimer measurement should be the initial step in the investigation of suspected venous thromboembolism. Chest 2003; 124:1116-9.
• 5. Owings JT, Gosselin RC, Battistella FD, Anderson JT, Petrich M, Larkin EC. Whole blood D-dimer assay: an effective noninvasive method to rule out pulmonary embolism. J Trauma 2000;48:795-.
• 6. Schietroma M, Carlei F, Mownah A, Franchi L, Maz-zotta C, Sozio A, et al. Changes in the blood coagulation, fibrinolysis, and cytokine profile during laparoscopic and open cholecystectomy. Surg En-dosc 2004;18:1090-6.
• 7. Chen JP, Rowe DW, Enderson BL. Contrasting post-traumatic serial changes for D-dimer and PAI-1 in critically injured patients. Thromb Res 1999;94:175-85.
• 8 Owings JT, Gosselin RC, Anderson JT, Battistella FD, Bagley M, Larkin EC. Practical utility of the D-dimer assay for excluding thromboembolism in severely injured trauma patients. J Trauma 2001 ;51:425-30.
• 9. Codine P, Barbotte E, Denis-Laroque F, Lansac H, Dupetit T, Pradies F, et al. C-reactive protein, leukocyte count and D-dimer monitoring after orthopedic surgery: early diagnosis of infectious or thrombo embolic complications. Part two: Does D-dimer measurement contribute to the diagnosis of postoperative venous thromboembolism? Ann Readapt Med Phys 2005;48:598-602 Epubs.
• 10. Xu G, Zhang ZL, Huang W. Relationship between plasma D-dimer levels and clinic pathologic parameters in respectable colorectal cancer patients. World J Gastroenterology 2004;10:922-3.
• 11. Oya M, Akiyama Y, Okuyama T, Ishikawa H. High preoperative plasma D-dimer level is associated with advanced tumor stage and short survival after curative resection in patients with colorectal cancer. Jpn J Clin Oncol 2001;31:388-94
• 12. Kılıç M, Yoldaş O, Keşkek M, Ertan T, Tez M, Göçmen E, et al. Prognostic value of plasma D-dimer levels in patients with colorectal cancer. Colorectal Diseaes 2008;3:238-41.
• 13. Prisco D, De Gaudio AR, Carla R, Gori AM, Fedi S, Celia AP, et al. Video laparoscopic cholecystectomy induces a hemostasis activation of lower grade than does surgery. Surg Endosc 2000;14:170-4.
• 14. Martinez-Ramos C, Lopez-Pastor A, Nunez -Pena JR, Gopegui M, Sanz-Lopez R, Jorgensen T, et al. Changes in hemostasis after laparoscopic cholecystectomy. Surg Endos 1999;13:476-9.
• 15. Rahr HB, Fabrin K, Larsen JF, Thorlacius-Ussing 0. Coagulation and fibrinolysis during laparoscopic cholecystectomy. Throm Res 1999;93:121-7.
• 16. Lippi G, Veraldi GF, Fraccaroli M, Manzato F, Cor-diano C, Guidi G. Variation of plasma D- dimer following surgery: implications for prediction of postoperative venous thromboembolism. Clin Exp Med 2001;1:161-4.
• 17. Sasaki K, Senda M, Ishikura T, Ota H, Mori T, Tsukiyama H, et al. The relationship between ambulation ability before surgery and the D-dimer value after total hip arthroplasty: the evaluation of ambulation ability by the timed "Up & Go” test. Acta Med Okayama 2005;59:222-30.
• 18. Boldt J, Hüttner I, Sutner St, Kümle B, Piper SN, Berchthold G, et al. Changes of haemostasis in patients undergoing major abdominal surgery- is there a difference between elderly and younger patients? BrJAnaesth 2001;87:435-40.
• 19. Levy G, Levy PY, Hessmann J, Monin P. Diagnosis of post-operative venous thrombosis using determination of plasma D-dimer. J Mal Vase 1998;23:269-73.
• 20. Bounameaux H, Miron MJ, Blanchard J, de Moer-loose P, Hoffmeyer P, Leyvraz PF. Measurement of plasma D-dimer is not useful in the prediction or diagnosis of postoperative deep vein thrombosis in patients undergoing total knee arthroplasty. Blood Coagul Fibrinolysis 1998;9:749-52.
• 21. Peetz D, Hafner G, Hansen M, Mayer A, Rippin G, Rommens PM, et al. Dose-adjusted thrombosis prophylaxis in trauma surgery according to levels of D-dimer. Throm Res 2000;98:473-83.