Incidence, Diagnosis, and Risk Factors of Venous Thromboembolism after Surgery for Malignant Bone and Soft Tissue Tumor of Lower Extremity

Abstract

Objective: This study aimed to prospectively evaluate the incidence, characteristics, and risk factors of venous thromboembolism (VTE) development, and the diagnostic value of blood coagulation markers in patients receiving surgery for malignant bone and soft tissue tumor of lower extremity. Methods:A prospective study of 20 patients who were examined using ultrasonography. Serum soluble fibrin monomer complex (SFMC) and D-dimer were measured in the perioperative period. VTE incidence, VTE development time, change in blood coagulation markers, and effect of each risk factor were evaluated.Results:VTE was found in 8 of 20 patients. Four of these 8 patients had the finding of pulmonary embolism (PE) without symptom. Onset time of VTE was from day 1 to 7 after surgery. The cutoff value of SFMC was <3 µg/mL at any measurement point and D-dimer was approximately 2 µg/mL in receiver operating characteristic analysis. Body mass index was the only significant risk factor. Conclusion: VTE showed high incidence and often occurred in the early period in only physical prophylaxis after surgery. SFMC or D-dimer was not always useful to detect VTE development. With regard to rehabilitation intervention, risk management is required until 1 week after surgery.

Thromboembolism in Malignant Musculoskeletal Tumour: A Literature Review

“…Modalities used in anticancer therapies such as central venous line, blood transfusion, chemotherapy, and surgical therapy which were also found to increase the risk of thrombus formation [ 13 ]. Yoshimura et al found that the risk of venous thromboembolism postoperatively in patients receiving surgery for malignant bone and soft tissue tumours in the lower extremity is increased, with high body mass index (BMI) which was found to be a significant risk factor contributing to the formation of thrombus [ 14 ]. Groot et al found that the risk of postoperative venous thromboembolism increased significantly in patients receiving surgery for the treatment of long bone metastases [ 15 ].…”

“…Laboratory diagnostic for measuring coagulation markers such as D-dimer was found to be of no use in diagnosing thromboembolism in cancer patients. Yoshimura et al found that only 1 case out of 8 VTE cases diagnosed using enhanced CT was found to have elevated level of D-dimer above 10 μ g/mL [ 14 ]. However, Kaiser et al found that high preoperative white blood cell count is a significant independent risk factor for venous thromboembolism in primary osteosarcoma patients.…”