Objectives: To analyze the incidence and predictors of deep vein thrombosis (DVT) in patients with elevated D-dimer prior to surgery for urologic malignancy. Methods: Between January 2015 and September 2017, 987 consecutive patients underwent surgery for urologic malignancy under general anesthesia in our institution. Of these, 191 patients underwent preoperative venous ultrasonography of the lower extremities for DVT due to elevated D-dimer. We analyzed the incidence and predictors of DVT in these patients. Results: The median age was 69 years. DVT was detected in 18% of patients (35/191). Multivariate analysis showed that the primary site of urologic malignancy (p < 0.01) and older age (p < 0.01) were independent predictors of DVT. Patients with bladder cancer had the highest incidence of DVT. When bladder cancer and age of 70 or older were defined as predictors for DVT, the incidence of DVT in zero, 1, and 2 predictors was 3.4% (3/89), 29% (22/77), and 44% (11/25), respectively. Conclusions: DVT was found in 18% of patients with elevated D-dimer prior to surgery for urologic malignancy. Bladder cancer patients and older patients in whom D-dimer has been elevated should undergo careful early examination for DVT.

Keywords:
Deep vein thrombosis, Predictor, Surgery, Urologic malignant tumor, Venous thromboembolism
1.
Streiff MB, Agnelli G, Connors JM, Crowther M, Eichinger S, Lopes R, et al. Guidance for the treatment of deep vein thrombosis and pulmonary embolism.
J Thromb Thrombolysis
. 2016 Jan;41(1):32–67.
2.
Bezemer ID, van der Meer FJ, Eikenboom JC, Rosendaal FR, Doggen CJ. The value of family history as a risk indicator for venous thrombosis.
Arch Intern Med
. 2009 Mar;169(6):610–5.
3.
Kolomansky A, Hoffman R, Sarig G, Brenner B, Haim N. Prospective evaluation of patients hospitalized with venous thromboembolism: comparison between cancer and non-cancer patients.
Isr Med Assoc J
. 2006 Dec;8(12):848–52.
4.
Khorana AA, Francis CW, Culakova E, Lyman GH. Risk factors for chemotherapy-associated venous thromboembolism in a prospective observational study.
Cancer
. 2005 Dec;104(12):2822–9.
5.
Stein PD, Beemath A, Meyers FA, Skaf E, Sanchez J, Olson RE. Incidence of venous thromboembolism in patients hospitalized with cancer.
Am J Med
. 2006 Jan;119(1):60–8.
6.
Huerta C, Johansson S, Wallander MA, García Rodríguez LA. Risk factors and short-term mortality of venous thromboembolism diagnosed in the primary care setting in the United Kingdom.
Arch Intern Med
. 2007 May;167(9):935–43.
7.
Heit JA, Silverstein MD, Mohr DN, Petterson TM, O’Fallon WM, Melton LJ 3rd. Risk factors for deep vein thrombosis and pulmonary embolism: a population-based case-control study.
Arch Intern Med
. 2000 Mar;160(6):809–15.
8.
Satoh T, Oki A, Uno K, Sakurai M, Ochi H, Okada S, et al. High incidence of silent venous thromboembolism before treatment in ovarian cancer.
Br J Cancer
. 2007 Oct;97(8):1053–7.
9.
Khorana AA, Francis CW, Culakova E, -Kuderer NM, Lyman GH. Thromboembolism is a leading cause of death in cancer -patients receiving outpatient chemotherapy. 
J Thromb Haemost
. 2007 Mar;5(3):632–4.
10.
Donati MB. Cancer and thrombosis.
Haemostasis
. 1994 Mar-Apr;24(2):128–31.
11.
de Moerloose P, Palareti G, Aguilar C, Legnani C, Reber G, Peetz D. A multicenter evaluation of a new quantitative highly sensitive D-dimer assay for exclusion of venous thromboembolism.
Thromb Haemost
. 2008 Sep;100(3):505–12.
12.
Hager K, Platt D. Fibrin degeneration product concentrations (D-dimers) in the course of ageing.
Gerontology
. 1995;41(3):159–65.
13.
Satoh T, Matsumoto K, Uno K, Sakurai M, Okada S, Onuki M, et al. Silent venous thromboembolism before treatment in endometrial cancer and the risk factors.
Br J Cancer
. 2008 Oct;99(7):1034–9.
14.
Hull RD, Hirsh J, Carter CJ, Jay RM, Ockelford PA, Buller HR, et al. Diagnostic efficacy of impedance plethysmography for clinically suspected deep-vein thrombosis. A randomized trial.
Ann Intern Med
. 1985 Jan;102(1):21–8.
15.
Goodacre S, Sampson F, Thomas S, van Beek E, Sutton A. Systematic review and meta-analysis of the diagnostic accuracy of ultrasonography for deep vein thrombosis.
BMC Med Imaging
. 2005 Oct;5(1):6.
16.
Antonopoulos CN, Sfyroeras GS, Kakisis JD, Moulakakis KG, Liapis CD. The role of soluble P selectin in the diagnosis of venous thromboembolism.
Thromb Res
. 2014 Jan;133(1):17–24.
17.
Cronin-Fenton DP, Søndergaard F, Pedersen LA, Fryzek JP, Cetin K, Acquavella J, et al. Hospitalisation for venous thromboembolism in cancer patients and the general population: a population-based cohort study in Denmark, 1997-2006.
Br J Cancer
. 2010 Sep;103(7):947–53.
18.
Khorana AA, Dalal M, Lin J, Connolly GC. Incidence and predictors of venous thromboembolism (VTE) among ambulatory high-risk cancer patients undergoing chemotherapy in the United States.
Cancer
. 2013 Feb;119(3):648–55.
19.
Chew HK, Wun T, Harvey D, Zhou H, White RH. Incidence of venous thromboembolism and its effect on survival among patients with common cancers.
Arch Intern Med
. 2006 Feb;166(4):458–64.
20.
Sandhu R, Pan CX, Wun T, Harvey D, Zhou H, White RH, et al. The incidence of venous thromboembolism and its effect on survival among patients with primary bladder cancer.
Cancer
. 2010 Jun;116(11):2596–603.
21.
Clément C, Rossi P, Aissi K, Barthelemy P, Guibert N, Auquier P, et al. Incidence, risk profile and morphological pattern of lower extremity venous thromboembolism after urological cancer surgery.
J Urol
. 2011 Dec;186(6):2293–7.
22.
De Martino RR, Goodney PP, Spangler EL, Wallaert JB, Corriere MA, Rzucidlo EM, et al. Variation in thromboembolic complications among patients undergoing commonly performed cancer operations.
J Vasc Surg
. 2012 Apr;55(4):1035–1040.e4.
23.
Monreal M, Büller H, Lensing AW, Bonet M, Roncales J, Muchart J, et al. Should patients with deep vein thrombosis alone be treated as those with concomitant asymptomatic pulmonary embolism? A prospective study.
Thromb Haemost
. 2002 Dec;88(6):938–42.
24.
Hughes MJ, Stein PD, Matta F. Silent pulmonary embolism in patients with distal deep venous thrombosis: systematic review.
Thromb Res
. 2014 Dec;134(6):1182–5.
© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.