Application value of Caprini risk assessment model and elevated tumor‐specific D‐dimer level in predicting postoperative venous thromboembolism for patients undergoing surgery of gynecologic malignancies

• Published in: The journal of obstetrics and gynaecology research 2019-03, Vol.45 (3), p.657-664
• Main Authors: Shi, Jun, Ye, Jing, Zhuang, Xu, Cheng, Xiaoyue, Fu, Ruojin, Zhao, Aimin
• Format: Article
• Language: English
• Subjects: Anticoagulants; Caprini risk assessment model; D‐dimer; Gynecological cancer; gynecological malignant tumor; Heparin; Lymph nodes; Metastases; Morbidity; perioperative period; Risk assessment; Surgery; Thromboembolism; venous thromboembolism
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/jog.13832

Aim Venous thromboembolism (VTE) is a major cause of morbidity and mortality in gynecologic malignant patients after surgery. We aimed to validate the Caprini risk assessment model (RAM) and elevated tumor‐specific D‐dimer as predictive marker of postoperative VTE for patients undergoing surgery of gynecologic malignancies. Methods Inpatients were divided into five groups (low: score = 0–1; moderate: score = 2; high: score = 3–4; higher: score = 5–7; sup‐high: score > 7) and treated according to their risk level after the surgery during the hospitalization according to the Caprini RAM. D‐dimer level was detected during the perioperative period. If D‐dimer did not fall to normal reference range on the seventh day after operation, the use of low‐molecular‐weight heparin was prolonged to 28 days after surgery. Results The majority (853/974, 87.6%) of the patients was in the Caprini score ≥5, with an overall VTE incidence of 1.75%. The VTE group had significantly higher Caprini score, CA125, vascular invasion rate and lymph node metastasis rate. If 1.5 μg/mL was used as the D‐dimer cut‐off value to predicting VTE, the sensitivity was 87.5%, the specificity was 93.8% and the negative predictive value was 99.2%. The D‐dimer level was a marker for prolonging the anticoagulants use during the perioperative period, especially for the sup‐high group. Conclusion The Caprini RAM is an effective and reliable VTE risk prediction tool for patients undergoing gynecological malignant tumor surgery. The group (score ≥ 5) can be divided into two subgroups (higher: score = 5–7 and sup‐high: score > 7), which may better predict the occurrence of VTE for malignant tumor patients. Great than 1.5 μg/mL D‐dimer before operation should be given more attention for the presence of VTE.