Sequential screening to predict symptomatic pulmonary thromboembolism after gynecologic surgery in Nara, Japan.

OBJECTIVE: To evaluate a sequential screening method's efficacy in predicting symptomatic pulmonary thromboembolism (PTE) after gynecologic surgery. METHODS: A prospective study employing a two-stage screening process was conducted among consecutive asymptomatic adults who underwent outpatient evaluation for gynecologic surgery at Nara Medical University Hospital, Japan, between April 1, 2004, and December 31, 2013. Patients with a preoperative plasma D-dimer level greater than or equal to 1.0μg/mL underwent compression ultrasonography of the lower extremities. The primary outcome measure was postoperative detection of symptomatic PTE. RESULTS: Overall, 1729 patients were included. The mean D-dimer level was 1.7±3.3μg/mL. Compression ultrasonography was conducted among 470 (27.1%) patients with positive D-dimer test results; symptomatic deep vein thrombosis (DVT) was preoperatively detected among 94 (20.0%) of them. Patients with DVT (n=94) had higher D-dimer levels than patients (n=1635) without (7.8±12.8μg/mL vs 1.1±1.8μg/mL; P<0.001). Despite anticoagulant therapy, symptomatic PTE was detected postoperatively among two of these 94 patients. Symptomatic PTE was also detected among four of 376 patients with positive D-dimer test results but no evidence of DVT by ultrasonography. No clinical onset of postoperative PTE was observed among 1259 patients with D-dimer levels below the cut-off value. CONCLUSION: The PROVEN screening strategy (Preoperative surveillance using a sequential strategy) was ineffective at predicting postoperative symptomatic PTE.;博士(医学)・乙第1375号・平成28年3月15日;Copyright © 2015 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.;開始ページ : 42;終了ページ : 45;PubMed番号 : http://www.ncbi.nlm.nih.gov/pubmed/26442455;http://www.ijgo.org/article/S0020-7292(15)00598-6/abstract

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書名 Sequential screening to predict symptomatic pulmonary thromboembolism after gynecologic surgery in Nara, Japan.
著作者等 International Federation of Gynecology and Obstetrics
Hirai Toshiko
Kawaguchi Ryuji
Kobayashi Hiroshi
Haruta Shoji
書名別名 婦人科手術術後の症候性肺血栓塞栓症予防スクリーニングの有用性についての検討
出版元 Elsevier
ISSN 00207292
NCID AA00680363
AA11531172
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言語 英語
出版国 スウェーデン
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