Silent venous thromboembolism before treatment in endometrial cancer and the risk factors

Deep vein thrombosis (DVT) and subsequent pulmonary thromboembolism (PTE) represent potentially lethal perioperative complications associated with major pelvic or abdominal operations (Turpie et al, 2002). Deep vein thrombosis is known to occur in the postoperative period or during the course of postoperative therapy in 9.8–57.1% of patients with endometrial carcinoma (Clarke-Pearson et al, 1983; Crandon and Koutts, 1983; Gore et al, 1984; von Tempelhoff et al, 2000). Several guidelines (Greets et al, 2001; Nicolaides et al, 2001, Committee on Practice Bulletins – Gynecology, American College of Obstetricians and Gynecologists, 2002) have focused on intra- and postoperative management for preventing venous thromboembolism (VTE). For the prevention of postoperative DVT, we usually use elastic stockings during surgery and intermittent pneumatic compression during and after surgery. However, if DVT exists before the treatment of endometrial carcinoma, such preventative measures may be ineffective or possibly dangerous for lethal PTE. D-dimer (DD) is a degradation product of fibrin and reflects fibrin concentration. Although increased plasma DD level is generally thought to be associated with the presence of DVT, the positive predictive value of DD is 36–44%. Conversely, the negative predictive value of DD is 89–100% (Bounameaux et al, 1991; Harrison et al, 1993; Wells et al, 2003; Righini et al, 2006). We have recently reported that increased DD levels are associated with the presence of silent VTE before treatment in ovarian cancer (DD <1.5 μg ml−1, 0 of 26 (0%); DD ⩾1.5 μg ml−1, 18 of 46 (39%)) (Satoh et al, 2007). A suitable cutoff value for detecting VTE in patients with ovarian cancer seems to be 1.5 μg ml−1, which offers 100% sensitivity and 100% negative predictive value, despite low specificity (47.2%) and low positive predictive value (38.3%). This study therefore aimed to clarify the incidence of VTE before treatment in endometrial caner patients with DD ⩾1.5 μg ml−1 and associated risk factors.