Early detection of venous thromboembolism in patients with neuroepithelial tumor: efficacy of screening with serum d-dimer measurements and Doppler ultrasonography
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- Kawaguchi, T., Kumabe, T., Kanamori, M. et al. J Neurooncol (2011) 101: 495. doi:10.1007/s11060-010-0276-8
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The efficacy of combined serum d-dimer level measurement and Doppler ultrasonography of the lower extremity was investigated for screening of venous thromboembolism (VTE) in patients with neuroepithelial tumor. Eighty-one patients with neuroepithelial tumor were prospectively studied. All patients underwent measurement of serum d-dimer levels and Doppler ultrasonography of the lower extremity. The serum d-dimer level was measured every week, and Doppler ultrasonography was performed two and two weeks after surgery, then every two weeks until discharge, or every two weeks for patients who did not undergo surgery. If the serum d-dimer level increased over 10.0 μg/ml, Doppler ultrasonography or computed tomography was performed to detect VTE. VTE occurred in 12 (14.8%) patients (seven males and five females; age 34–75, mean 59.0 years). Only one patient was symptomatic, whereas 11 patients identified by the screening were without symptoms. Five patients were treated with anticoagulant therapy, one with prophylactic inferior vena cava filter placement with anticoagulant therapy, and the other six were closely followed up without medication. No patient died of pulmonary embolism. Serial Doppler ultrasonography showed thrombus regression or organization and no thrombus extension. The maximum serum d-dimer value was significantly higher in patients with VTE than in those without VTE (mean 14.5 vs. 3.46 μg/ml, P < 0.001). The d-dimer cutoff value of 5.4 μg/ml could be used to identify VTE with 83% sensitivity and 84% specificity. The combination of sequential serum d-dimer measurement and Doppler ultrasonography of the lower extremity is an efficient and non-invasive procedure for identifying asymptomatic VTE in patients with neuroepithelial tumor.