Preoperative D-dimer Levels Research Articles

Prevalence of Thrombophilia and Thrombogenic Factors among 122 Heart Transplant Recipients

Purpose Thrombophilia (TF) and thrombogenic risk factors may affect the postoperative and long-term outcome after heart transplantation (HTX). We evaluated the prevalence of TF and thrombogenic risk factors among HTX candidates. The ultimate goal will be to analyze patient outcome in relation to preoperative findings of hypercoagulable factors upon the completion of the follow-up of ten years by 12/2012. Methods and Materials Patients with severe heart failure were prospectively screened in association with HTX routines during 2003-2011. TF screening comprised of Factor V Leiden (FVL) and prothrombin G20210A mutations, antithrombin (AT), lupus anticoagulant, cardiolipin and β2-glycoprotein I IgG antibodies. Thrombogenic risk factors included FVIII:C, thrombin time, fibrinogen (FG), and D-dimer at HTX screening and again Results In all, 136 HTX were performed and 122 recipients (60% males) had full TF screening. 55% of the patients had cardiomyopathy, 24% ischemic heart failure, 9% myocarditis or inflammatory heart disease, and 7% congenital heart disease. 80% used warfarin anticoagulation. Mean age was 49 (range 18-67) years. During the follow-up (range 11-109 months) 20 HTX recipients (16%) died. TF was established in 10%; 5 FVL (4%), 1 prothrombin mutation (0,8%) and 6 positive cardiolipin antibodies (5%). As main preoperative findings mean FG and D-dimer levels were elevated, 4.6±1.3 g/L (normal 1.7-4.0) and 1.0 ± 2.1 mg/L (normal 190%, normal 52-148) in 40 (33%) patients. AT was low ( Conclusions The prevalence of TF among HTX recipients was similar to normal population. Acquired thrombogenic factors were upregulated, despite the anticoagulant treatment, compatible with coagulation activity in severe heart failure. In one third of the patients FVIII was clearly elevated reflecting endothelial activation and acute phase reaction. Antithrombin, however, maintained its activity in the vast majority of the patients.

Abstract P1-01-26: Procoagulant biomarkers may direct axillary nodal surgery

Abstract Background: Preoperative accurate staging of the axilla (through identifying invasive breast cancers with subclinical nodal metastases) will reduce the need for repeat axillary surgery. Tissue factor (TF) is overexpressed in cancer and is shed into the circulation leading to activation of the thrombin (extrinsic clotting) pathway. D-dimer is a fibrin degradation product and reliable systemic marker of thrombin pathway activation. TF and d-dimer are raised in breast cancer and may act as biomarkers to identify invasive cancer patients with undiagnosed lymph node (LN) metastases requiring axillary nodal clearance. Methods: Plasma d-dimer and TF were measured pre-operatively using ELISA in patients undergoing curative surgery and sentinel node biopsy (SNB) for invasive breast cancer (n = 125). D-dimer was considered to be raised if it was above the clinically used upper limit of normal of 500ng/ml and if TF was above 200pg/ml. D-dimer and TF were correlated with the presence or absence of axillary metastases at sentinel node biopsy. Results: Median age was 61 years (range 24–84). Mean invasive tumour size was 16.7 mm (range 1.6–70). One hundred and eleven (79%) invasive cancers were oestrogen receptor positive, 93 (67%) were progesterone receptor positive and 17(12%) were HER2 receptor positive. Pre-operative d-dimer was higher in LN positive (mean 599 ng/ml, 95% CI 415–864, n=32) versus LN negative (454ng/ml, 95% CI 400–514, n=93, p = 0.068) invasive cancer. TF was not significantly higher in LN positive cancer (vs LN negative), although TF did show weak correlation with d-dimer (r = 0.2, p = 0.03). Sixty eight patients (54%) had raised TF and 59 (47%) had raised d-dimer. On multivariate analysis (age, tumour size, invasive grade, ER status and presence of lymphovascular invasion as covariates) a raised pre-operative d-dimer combined with a raised pre-operative TF was a significant independent predictor of node positivity (odds ratio 6.43, CI 1.70–24.27, p = 0.006). Markers of systemic thrombin pathway activity (i.e. a combination of plasma d-dimer and TF) had a sensitivity of 91%, specificity of 32%, positive predictive value of 32% and negative predictive value of 92%. Conclusion: High levels of clotting activation are seen in breast cancer patients. Over 90% of patients with no axillary lymph node metastases had normal pre-operative levels of plasma TF and d-dimer. Combination of systemic markers of thrombin pathway activation may help predict axillary nodal involvement. The role of thrombin pathway activation in breast cancer metastasis is under ongoing investigation. Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-01-26.

Preoperative plasma D‐dimer predicts 1‐year survival in colorectal cancer patients with absence of venous thromboembolism (VTE): a prospective clinical cohort study

Fibrin formation is required for tumor angiogenesis, metastasis and invasion. Cancer discovered at the same time as or shortly after venous thromboembolism (VTE) tends to be advanced, and the prognosis poor. Previous studies have demonstrated that plasma D-dimer - a degradation product of cross-linked fibrin - correlates with tumor stage and prognosis in patients with colorectal cancer. However, it remains unclear whether D-dimer is of prognostic significance in colorectal cancer patients with absence of VTE. To examine whether the preoperative plasma D-dimer level predicts 1-year survival in pre- and postoperative VTE-negative colorectal cancer patients admitted for surgery. We measured preoperative D-dimer levels in 157 patients, and computed Kaplan-Meier survival curves according to the levels of D-dimer. Cox proportional-hazard regression analysis was used to compute hazard ratio as a measure of 1-year mortality rate ratio, controlling for potential confounding factors. The Aalborg Hospital's standard cut-off level of 0.3 mg L(-1) was used to distinguish negative and positive D-dimer results. The overall 1-year survival rate was 87.3% (95% confidence interval (CI), 81.0-91.6%), with 78.1% survival (95% CI, 65.9-86.4%) in the positive D-dimer group compared with 93.6% survival (95% CI, 86.2-97.1%) in the negative D-dimer group. The adjusted hazard ratio of death in the positive D-dimer group compared with the negative D-dimer group was 3.6 (95% CI, 1.3-9.9). A positive preoperative D-dimer is associated with a poor prognosis in colorectal cancer patients with absence of VTE.

Serum D-Dimer as a Prognostic Marker in Patients Undergoing Radiofrequency Ablation of Colorectal Liver Metastasis

ABSTRACTBackground: Although traditionally used for coagulation disorders, there has been a recent interest in serum D-dimer as a tumor marker. The aim of this prospective study is to determine its value as a tumor marker in patients with colorectal liver metastasis. Patients and Methods: Between January 2000 and October 2007, 242 patients undergoing laparoscopic radiofrequency ablation (RFA) of colorectal liver metastasis were evaluated prospectively. The relationship of D-dimer levels to pre-ablation parameters, recurrence, and survival was prospectively assessed. All data are expressed as mean ± SEM. Results: Preoperative D-dimer levels correlated with liver tumor volume (p = .04) and CEA (p = .003). D-dimer levels increased by a mean of 11.4 ± 1.5 folds after RFA on POD#7 and returned to preoperative values in three months. The rate of the elevation of D-dimer values after RFA was related to tumor volume ablated. The median overall survival was six months for patients with preoperative D-dimer > 1,000 ng/ml vs. 32 months for patients with D-dimer < 1,000 ng/ml (p = .02). On multivariate analysis preoperative serum D-dimer was an independent predictor of overall survival along with CEA and liver tumor burden. Conclusion: Serum D-dimer levels reflect liver tumor burden and independently predict survival in patients with colorectal liver metastasis undergoing RFA.

Incidence and predictors of deep venous thrombosis after abdominal oncologic surgery: Prospective Doppler ultrasound screening

BackgroundVenous thromboembolism is a relatively rare but serious complication of abdominal surgery. This study evaluated the incidence and risk factors for the development of deep venous thrombosis (DVT) after abdominal oncologic surgery using color Doppler ultrasonography (DUS). MethodsThis study enrolled 132 consecutive patients who underwent elective abdominal surgery for malignant tumors. Patients were investigated for DVT using DUS on postoperative day 7±2. Correlations between the incidence of DVT and clinicopathologic parameters and the postoperative course were evaluated. ResultsDVT was found in 15 patients (11.4%) using DUS. Clinically evident venous thromboembolism, including pulmonary embolism, was not found in these patients. The incidence of DVT was significantly higher in females (P=0.002), patients with a lower body mass index (P=0.008), and patients with a higher preoperative D-dimer level (P<0.0001). ConclusionsDUS is noninvasive and is useful for postoperative DVT screening. Thromboprophylaxis is essential in high-risk patients who have undergone abdominal oncologic surgery.

Clinical analysis of postoperative venous thromboembolism risk factors in lung cancer patients

The objective of this study is to explore clinical risk factors for venous thromboembolism (VTE) in postoperative lung cancer patients in order to provide a basis for the prevention and treatment of postoperative VTE. A total of 1,001 lung cancer patients were retrospectively analyzed. Each patient was confirmed with surgical pathology diagnosis and had a complete clinical and follow-up record. VTE was identified in a combination of spiral computed tomography (CT), pulmonary angiography, and color Doppler ultrasound. We used life table method to create an occurrence frequency curve of thrombosis. We also searched for high risk factors for postoperative VTE with Cox multivariate regression model and created frequency curves of thrombosis against different risk factors using Kaplan-Meier method. As of July 31, 2011, the median follow-up time is 25.73 ± 0.11 months (19.23-31.37). The cumulative frequency of VTE among 1,001 lung cancer patients is 2%, 3%, 4%, 5%, and 5.3% over 1, 3, 6, 12, and 30 months after the surgery. COX regression analysis showed that the hazard ratio of VTE occurrence in patients with incomplete resection relative to ones with complete resection is 9.867 (95% CI: 5.275-18.459, P = 0.000). And the hazard ratio of VTE occurrence is 3.472 (95% CI: 1.761-6.845, P = 0.000) in patients with anti-angiogenesis treatment compared to patients without such treatment. The hazard ratio of VTE occurrence is 2.808 (95% CI: 1.439-5.479, P = 0.002) in patients with EGFR-TKI treatment relative to patients without the treatment, and 7.520 (95% CI: 3.968-14.250, P = 0.000) in patients with an increase in D-dimer level relative to normal ones The highest incidence of VTE is within 1 month after lung cancer surgery. High risk factors for VTE include incomplete surgical resection, postoperative use of anti-angiogenesis drugs, EGFR-TKI application and an increase in preoperative D-dimer level.

PO-14 Preoperative D-dimer levels predict long-term disease-free survival in patients with curatively intended resection for stage III colorectal cancer: a prospective cohort study

PO-14 Preoperative D-dimer levels predict long-term disease-free survival in patients with curatively intended resection for stage III colorectal cancer: a prospective cohort study

Plasma D-dimer level in the perioperative period in non-small-cell lung cancer.

There has been little research on perioperative hypercoagulability in non-small-cell lung cancer patients. The D-dimer can be used to evaluate the hypercoagulability in cancer patients. Eighty-five non-small-cell lung cancer patients were included in the study. The plasma D-dimer levels during the preoperative and 3rd and 9th day postoperative period were prospectively examined and analyzed along with the clinicopathological characteristics. The medians (interquartile range) of the preoperative, 3rd and 9th day postoperative D-dimer levels were 1.09 (0.77) mg/L, 3.35 (2.31) mg/L and 4.1 (2.55) mg/L respectively (P= 0.00). The preoperative D-dimer level was related with the stage (P= 0.004). The preoperative and the 3rd day postoperative D-dimer levels were both related to patient age (P= 0.014, P= 0.034). The 3rd day postoperative D-dimer levels were arbitrarily stratified into three groups, adenocarcinoma dominated the high and low groups while squamous cell carcinoma dominated the median one (exact P= 0.02). The pneumonectomy group did not show a higher 3rd day postoperative D-dimer level than the lobectomy group (P= 0.064). Non-small-cell lung cancer patients had increasing hypercoagulability within the first 9 postoperative days. Preoperative hypercoagulability was close related with tumor stage. Heterogeneity existed among postoperative hypercoagulability.

Changes in D-dimer levels after cesarean section in women with singleton and twin pregnancies

ObjectiveTo determine how the D-dimer level changes after cesarean section, a topic that has not been studied extensively. MethodsThe D-dimer level (μg/mL) was measured in 792 and 119 women with singleton and twin pregnancies, respectively, on the day or one day before cesarean section and on postpartum days 1, 3, and 7. None of the women developed venous thromboembolism with clinical symptoms. The data for other two women who underwent a cesarean section and developed pulmonary thromboembolism on postpartum days 0 to 1 were also presented. ResultsThe preoperative D-dimer level (median, μg/mL) of 2.4 increased on postpartum day 1 to 6.0, then decreased to 2.8 on postpartum day 3, and again increased to 4.5 on postpartum day 7 in the singleton pregnancies. A similar pattern, but with slightly higher values, was seen in the twin pregnancies. The 95 percentile value of D-dimer for singleton and twin pregnancies was 6.9 and 10.5 on days –1/0, 19.7 and 25.7 on day 1, 9.7 and 13.5 on day 3, and 15.7 and 17.7 on day 7, respectively. The D-dimer level after pulmonary thromboembolism was greater than the 99 percentile value and the 98 percentile value in the two women, respectively. ConclusionOur data regarding the D-dimer level may be helpful when considering the normal range of D-dimer for postpartum women with cesarean delivery.

심혈관질환의 수술기주위 결과예측에 있어 수술 전 백혈구 수 및 D-dimer 농도의 임상적 유용성

이 연구는 관상동맥질환 수술기주위의 결과예측에 있어 수술 전 백혈구 및 D-dimer 수치가 유용한 인자가 될 수 있는지를 규명하기 위해 회고적으로 실시하였다. 수술 전 백혈구 수는 수술 전 및 후의 심장표지자인 troponin-I, creatine kinase-MB, C-반응단백 각각의 농도와 정의 상관성이 있었다. 수술 전 D-dimer 농도 역시 수술기주위의 심장표지자들과 정의 상관관계를 보였다. 수술 전 백혈구 수는 간표지자인 aspartate aminotransferase 및 alanine aminotransferase의 수술 전후 농도와 정의 상관관계를 보였는데 비해, 수술 전 D-dimer 농도는 수술 전후 빌리루빈 농도, 수술 전 글루코스 농도, 수술 후 크레아티닌 농도와 각각 정 또는 역의 상관관계가 있었다. 수술 전 백혈구 및 D-dimer 수치 둘 다 수술 전 고밀도콜레스테롤 농도 및 좌심실구출계수와 각각 역의 상관관계가 있었다. 수술전 백혈구 수는 수술시간 및 수술 후 기계보조 호흡시간과 각 정의 상관관계를 보였고, 수술 전 D-dimer 농도는 수술 후 기계보조 호흡시간, 중환자실 치료기간, 재원기간과 각 정의 상관관계가 있었다. 이 회고적 조사의 결과는 수술 전 백혈구 및 D-dimer 수치가 관상동맥수술 환자들의 수술기주위 결과예측에 있어 임상적으로 유용한 인자들이 될 수 있음을 시사하고 있다. The present study was retrospectively designed to define whether preoperative levels of leukocytes and D-dimer are potentially useful factors in predicting perioperative outcomes of coronary heart disease (CHD). There was no relationship between preoperative leukocyte counts (Pre-OP leukocyte) and preoperative D-dimer levels (Pre-OP D-dimer). Pre-OP leukocyte counts each had positive correlation with cardiac troponin-I, creatine kinase-MB or C-reactive protein (cardiac markers) levels at preoperative and postoperative periods. Pre-OP D-dimer levels were positively associated with each cardiac marker at the same periods. Pre-OP leukocyte counts positively related with aspartate aminotransferase and alanine aminotransferase (liver markers), whereas Pre-OP D-dimer level positively or negatively correlated with bilirubin (liver marker), creatinine (renal marker) or glucose levels at preoperative and/or postoperative periods. Pre-OP leukocyte and Pre-OP D-dimer were inversely associated with Pre-OP high density lipoprotein cholesterol levels or left ventricular ejection fraction. Pre-OP leukocyte counts each had positive correlation operation duration and postoperative mechanical ventilation-time (PMVT), whereas Pre-OP D-dimer levels had positive relationship with PMVT, intensive care unit-staying period and hospitalization. The retrospective data suggest that Pre-OP leukocyte and Pre-OP D-dimer levels may be clinically useful factors for predicting perioperative outcomes in patients with CHD.

Antiinflammatory Actions of HDL

Atherosclerosis is an inflammatory disorder characterized by the accumulation of macrophages and T-lymphocytes in the arterial intima. The macrophages are derived from blood monocytes that adhere to, and transmigrate across, an activated or injured endothelial surface. The firm adhesion of monocytes to the endothelium requires expression of integrins such as CD11/CD18 on the monocyte surface and endothelial expression of the adhesion molecules vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and E-selectin. Monocytes that are firmly tethered to the endothelium transmigrate into the subendothelial space in a process that is dependent on endothelial expression of chemokines such as monocyte chemotactic protein-1 (MCP-1).1 See accompanying article on page 2071 After entering the artery wall, monocytes differentiate into macrophages in processes that are mediated by macrophage colony stimulating factor (CSF) and granulocyte-macrophage CSF.2 Macrophages express a range of scavenger receptors that bind and internalize modified LDL in an unregulated manner. This leads to a progressive accumulation of lipids in the macrophages and the formation of foam cells: the hallmark cells of atherosclerotic lesions. The results of numerous epidemiological studies have established that …

Prognostic value of plasma D‐dimer levels in patients with colorectal cancer

Plasma D-dimer levels have been shown to be increased in patients with various solid tumours including lung, prostate, cervical, ovarian, breast and colon cancer. The purpose of this prospective study was to estimate the plasma D-dimer level of patients with colorectal cancer before surgery and to assess whether it has a prognostic value. The study comprised 51 patients with colorectal cancer. Variables including demographic, clinical, operative and pathological findings and routine laboratory tests were recorded. In addition, tumour markers, coagulation tests and plasma D-dimer levels were evaluated. Histological types other than well-differentiated adenocarcinoma, relatively advanced tumour stage and a high preoperative plasma D-dimer level were the prognostic factors that were associated with shorter postoperative survival according to univariate analyses. The presence of vascular invasion was associated with higher preoperative D-dimer levels. However, there was no statistically significant relationship between postoperative survival and the presence of vascular invasion. Postoperative survival was significantly shorter in colorectal cancer patients with elevated preoperative D-dimer levels. Evaluation of preoperative D-dimer level can be used to predict postoperative survival.

Incidence of Deep Vein Thrombosis after Major HipSurgery and Diagnostic Value of D-dimer

Purpose : To evaluate the incidence of deep vein thrombosis (DVT) after major hip surgery along with the efficacy of the D-dimer as a routine noninvasive - screening test for DVT. Materials and Methods : From May 2003 to August 2004, 289 patients who underwent major hip surgery were evaluated prospectively. All the patients underwent B-mode ultrasonography (US) preoperatively, and venography or US on postoperative 7 to 10 days. The D-dimer level was also estimated preoperatively, and at 3 and 7 days after surgery. Results : The preoperative D-dimer level was an average 0.60 ug/ml. DVT was encountered in 29 patients (10.1%) and in 28.9% of those over 60 years of age (p＜0.05). Three days after surgery, the average D-dimer level was 3.82 ug/ml in the DVT positive patients and 2.26 ug/ml in the DVT negative patients. Seven days after surgery, the average D-dimer level in the DVT positive and negative patients was 5.19 ug/ml and 2.89 ug/ml. The most predictable D-dimer level for DVT 3 and 7 days after surgery were 2.585 ug/ml and 3.625 ug/ml, respectively. Conclusion : The overall incidence of DVT in our patients undergoing major hip surgery seemed lower than in Western populations. However, there was a significantly increasing tendency if the development of DVT in the older age group. We also recommend a D-dimer assay at postoperative 7 days as a valuable screening test for detection of DVT.

Relationship between plasma D-dimer levels and clinicopathologic parameters in resectable colorectal cancer patients

To assess the clinical significance of the D-dimer levels and the relationship between plasma D-dimer levels and clinicopathologic parameters in operable colorectal cancer patients. The plasma levels of D-dimer were measured pre- and postoperatively in 35 patients with colorectal cancer, and 30 healthy subjects served as controls by the method of quantitative enzyme-linked immunosorbent assay (ELISA). The mean preoperative plasma levels of D-dimer in the patients with colorectal cancer (1.06+/-0.24 mg/L) were significantly higher than those of controls (0.33+/-0.12 mg/L,P<0.01). The D-dimer levels were remarkably elevated on the 1st day after operation (1.22+/-0.55 mg/L, P<0.01). On the 3rd day the level of D-dimer began to stepwise descend and on the 14(th) day nearly returned to control level. The preoperative levels of D-dimer were significantly correlated with the lymph node metastasis and Dukes stage but had no association with tumor location and the degree of differentiation. A stepwise increase in the mean D-dimer levels was found with increase of the tumor stage. Hypercoagulation and higher fibrinolytic activities occur in patients with colorectal cancer. The operative trauma could enhance the fibrinolysis in the patients with colorectal cancer. The measurement of preoperative D-dimer levels is considered to be useful for predicting lymph node metastasis and stage of colorectal cancer.

Comparison of plasma D-dimer and thrombus precursor protein in patients with operable breast cancer as a potential predictor of lymph node metastasis.

Fibrin formation and removal is continuous during the development of malignancy. Plasma D-dimer is indicative of ongoing fibrinolysis, and circulating soluble fibrin polymer [thrombus precursor protein (TpP)] represents thrombogenic activity. We evaluated the relationship between plasma D-dimer and TpP levels with tumor extent and examined the use of these markers as possible predictors of lymph node metastasis in breast cancer. Preoperative plasma levels of D-dimer and TpP were measured in these 120 patients (93 breast cancer, 27 benign breast disease) and 29 healthy controls. Plasma levels of D-dimer in patients with breast cancer were significantly higher than in healthy controls and in those with benign breast disease. Plasma D-dimer levels in patients with breast cancer were found to be significantly increased according to tumor stage. We also observed that plasma levels of D-dimer were higher in patients with lymph node metastasis than in patients without metastasis. In contrast, TpP levels were not significantly different by the tumor stages and lymph node metastasis. In conclusion, increased D-dimer levels in breast cancer may suggest that an ongoing fibrinolysis within breast cancer tissue occurs during tumor progression. Positive D-dimer levels might be useful for identifying metastatic lymph node in patients with operable breast cancer. However, plasma TpP was not found to be a sensitive marker for detecting tumor-associated subclinical coagulopathy.

High preoperative plasma D-dimer level is associated with advanced tumor stage and short survival after curative resection in patients with colorectal cancer.

An elevated plasma D-dimer level indicates activation of coagulation and fibrinolysis. Previous studies demonstrated that the preoperative plasma D-dimer level correlates with tumor stage in patients with colorectal cancer. This study examined the relationship between preoperative plasma D-dimer level and both pathological findings and TNM classification and examined the prognostic significance of preoperative plasma D-dimer level. Preoperative plasma D-dimer levels were measured in 93 patients who underwent curative resection of colorectal cancer and 40 patients with benign colorectal diseases other than inflammatory bowel disease. The results were analyzed for correlations between preoperative plasma D-dimer levels in patients with colorectal cancer and pathological findings, TNM classification and postoperative survival. Preoperative plasma D-dimer levels were significantly higher in patients with colorectal cancer than in patients with benign colorectal diseases. Plasma D-dimer levels were higher in patients with tumors that were relatively large, had relatively deep wall penetration and were at a relatively advanced TNM stage. Higher preoperative plasma D-dimer levels were significantly associated with shorter postoperative overall survival. Results of analysis with a multivariate proportional hazard model suggested that preoperative plasma D-dimer level was the third strongest prognostic factor; exceeded in importance only by lymph node status and preoperative carcinoembryonic antigen level. Elevated plasma D-dimer levels in patients with colorectal cancer are associated with relatively advanced tumor stage and short postoperative survival after curative resection. It appears that measurement of preoperative D-dimer level would be useful in the preoperative diagnosis of tumor stage and prediction of postoperative survival.

Clinical significance of plasma D-dimer levels in patients with esophageal cancer

Objective: To investigate the clinical significance of the changes of D-dimer levels in patients with esophageal cancer. Methods: The plasma levels of D-dimer were measured pre-and postoperatively in 33 patients with esophageal cancer and 30 healthy subjects served as controls by the method of quantitative enzyme-linked immunosorbent assay (ELISA). Results: The mean preoperative plasma levels of D-dimer in the patients with esophageal cancer (1.98 mg/L±0.34 mg/L) were significantly higher than that of controls (0.33 mg/L±0.12 mg/L) (P<0.01). The D-dimer levels were remarkably elevated on the 1st day after operation (2.41 mg/L±0.55 mg/L) (P<0.01). On the 3rd day the level of D-dimer began to stepwise descend and on the 14th day near to control. The preoperative levels of D-dimer were significantly correlated with the tumor size but had no association with tumor location. A stepwise increase in the mean DD levels was found with the tumor stage. Conclusion: The hypercoagulation and fibrinolysis have occurred in patients with esophageal cancer. The operative trauma could enhance the fibrinolysis in the patients with esophageal cancer. The measurement of the preoperative DD levels is considered to be useful for the preoperative staging of esophageal cancer.

Coagulation and fibrinolysis in patients undergoing operation for ruptured and nonruptured infrarenal abdominal aortic aneurysms

Purpose : Hemorrhage and thrombosis predisposing to myocardial infarction, multiple organ failure, and thromboembolism account for the majority of the morbidity and mortality associated with repair of ruptured and nonruptured abdominal aortic aneurysms (AAAs). The aim of this study was to examine coagulation and fibrinolysis in patients operated on for ruptured and nonruptured infrarenal AAAs. Methods : Ten patients operated on for ruptured and 9 patients operated on for nonruptured AAAs were studied. Tissue plasminogen activator (t-PA) antigen, thrombin-antithrombin (TAT), and D-dimer were measured before induction of anesthesia. Plasminogen activator inhibitor (PAI) activity, t-PA activity, and prothrombin fragment (PF) 1+2 were measured before induction of anesthesia, immediately before aortic clamp release, and 5 minutes and 24 hours after aortic clamp release. Results : Preoperatively, ruptured AAA was associated with significantly elevated t-PA antigen (median 15.7 ng/mL, range 9.0 to 22.1 ng/mL versus nonrupture: median 6.6 ng/mL, range 4.7 to 16.4 ng/mL; P < .01, Mann-Whitney test), increased PAI activity (median 36.5 arbitrary units/mL, range 20.6 to 38.8 arbitrary units/mL versus nonrupture: median 8.2 arbitrary units/mL, range 3.2 to 21.7 arbitrary units/mL; P < .001), reduced t-PA activity (median 0.12 IU/mL, range 0.06 to 0.4 IU/mL versus nonrupture: median 0.49 IU/mL, range 0.14 to 3.2 IU/mL; P < .01), elevated TAT (median 135.5 μg/L, range 61.2 to 209.4 μg/L versus nonrupture: median 21.6 μg/L, range 6.6 to 180.4 μg/L; P < .02) and elevated PF 1+2 (median 9.0 nmol/L, range 5.4 to 11.6 nmol/L versus nonrupture: median 2.2 nmol/L, range 0.7 to 7.1 nmol/L, P < .001). There was no significant difference in preoperative D-dimer levels (median 3460 ng/mL, range 1236 to 7860 ng/mL versus nonrupture: median 1642 ng/mL, range 728 to 5334 ng/mL; P = .07). The differences in PAI activity, t-PA activity, and PF 1+2 persisted throughout the course of surgery, but there was no significant difference between the groups at 24 hours. Conclusion: These novel data demonstrate that ruptured AAA repair is associated with inhibition of systemic fibrinolysis and intense thrombin generation. Similar changes are seen in nonruptured AAA but are of a lesser magnitude. This procoagulant state may contribute to the microvascular and macrovascular thrombosis that leads to myocardial infarction, multiple organ failure, and thromboembolism. (J Vasc Surg 1999;30:641-50.)

Plasma D-dimer level in patients with colorectal cancer: its role as a tumor marker.

The purpose of this study was to explore the relationship between the preoperative plasma D-dimer (DD) levels and the tumor pathology of colorectal cancer. The plasma DD levels were measured preoperatively in 108 patients with colorectal cancer, and then were correlated with the tumor pathology and stage. The diagnostic value of the DD levels for the tumor stage was then compared with that of the preoperative carcinoembryonic antigen (CEA) levels. The preoperative DD levels were higher in patients with either a large-sized tumor or a tumor showing deep wall penetration. Lymph-node metastasis, lymphatic invasion, hepatic metastasis, and peritoneal dissemination were all associated with higher DD levels. A stepwise increase in the median DD level was found with the tumor stage. The preoperative DD levels also significantly correlated with CEA levels. When a cutoff value of 0.6 microg/ml was used in the DD assay, the sensitivity and specificity for Dukes C or D cancer were 67.2% and 64.0%, and those for Dukes D cancer were 91.3% and 57.6%, respectively. Although the DD assay was less specific, its diagnostic value in the preoperative staging of colorectal cancer was comparable to that of the CEA assay. The measurement of the preoperative DD level is thus considered to be useful for the preoperative staging of colorectal cancer.

An Activated State of Blood Coagulation and Fibrinolysis in Patients with Abdominal Aortic Aneurysm

Background: Relationships between blood coagulation and the fibrinolysis system and morphology of aneurysms in patients with abdominal aortic aneurysm (AAA) are unknown. Methods: Preoperative and postoperative evaluations of hemostatic factors such as thrombin-antithrombin III complex (TAT), D-dimer, fibrinogen/fibrin degradation products (FDP), and platelet count were performed in 36 patients with atherosclerotic AAA. As control subjects, 25 age- and sex-matched healthy volunteers were analyzed for these hemostatic factors. In all patients, morphological evaluation of AAA included the largest diameter, tortuosity, and the thickness of intraluminal thrombus to be compared with preoperative levels of hemostatic factors such as alpha-2 plasmin inhibitor-plasmin complex (PIC), thrombomodulin (TM), von Willebrand factor (vWF), tissue factor (TF), and free form of tissue factor pathway inhibitor (F-TFPI). Results: The preoperative values of TAT, D-dimer, and FDP were significantly higher in AAA patients than in controls. Of all patients, 23 (64%) or 22 (58%) had TAT or D-dimer values greater than 8.2 ng/mL or 3.4 μg/mL (mean + 2SD of controls), respectively. The postoperative values of these hemostatic factors significantly improved, but were not normalized. The largest diameter of AAA correlated with the preoperative levels of TAT ( r = 0.566, P = 0.001), D-dimer ( r = 0.644, P = 0.0001), FDP ( r = 0.561, P = 0.0009), PIC ( r = 0.413, P = 0.0146), and F-TFPI ( r = 0.408, P = 0.0158). We have also found that tortuosity of AAA has relation not only to the preoperative levels of fibrinolytic factors but also to the plasma F-TFPI antigen levels. On the other hand, the preoperative levels of a marker of endothelial damage, such as TM or vWF, and TF did not correlate with those of F-TFPI in all patients. The maximum thickness of thrombus in AAA significantly correlated not only with the preoperative levels of TAT, D-dimer, FDP, and PIC, but also with AAA size. Conclusions: We have found evidence that an activated state of both blood coagulation and fibrinolysis in AAA patients is associated with the morphological characteristics of aneurysms.