Early detection of thrombosis after cesarean section using changes in D-dimer levels

Aim: To identify important factors that can be used to predict the presence of venous thromboembolism (VTE) or pulmonary embolism (PE) after cesarean section. Methods: This retrospective study was conducted at Juntendo University Hospital from January to December in 2012. A total of 313 patients who underwent cesarean section were included. Complete blood count, biochemistry parameters, and parameters of coagulation-fibrinolysis, such as D-dimer levels, were examined on the day before cesarean section and on postoperative days 1, 3, and 5. Results: Six cases of VTE and / or PE were identified. We designed an equation that incorporates changes in D-dimer levels for predicting the presence of thrombosis, as follows: y = (D1 D-dimer) x 1.263 - (D3 D-dimer) x 1.741 + (D3 / D1 D-dimer) x 6.42 + (D5 D-dimer) x 4.029 - 53.248. When the resulting value is >20, the patient is considered likely to have thrombosis. Conclusions: This study showed that rate of change in D-dimer levels from postoperative day 1 to day 3, and D-dimer level itself on postoperative day 5, are important factors for predicting the presence of VTE or PE.