PLASMA CROSSLINKED FIBRIN DEGRADATION PRODUCTS FRACTION D (D-DIMER) IN PATIENTS UNDERGOING ELECTIVE MAJOR ABDOMINAL SURGERY AND IN HEALTHY VOLUNTEERS

An increased plasma level of D-dimer has been suggested as an indicator of postoperative thromboembolism (TE). We studied the D-dimer level in patients undergoing major elective abdominal surgery and in healthy volunteers to evaluate a possible value of D-dimer as a screening test for TE. 18 patients and 5 healthy volunteers were studied. The patients received low molecular weight heparin (Logiparin TM) subcutaneously once . daily for 7 days. The 125 I-fibrinogen uptake test (FUT) was done in all patients. Blood samples were taken preoperatively, postoperatively and on the postoperative day 1, 3, 4, 5 and 6. The volunteers had blood samples taken before and 4 hours after subcutaneous Logiparin injection. D-dimer was assayed by enzyme-immunoassay (Boehringer Mannheim, Elisa D-dimer, Cat.no. 998117). Results are given as median with 95% confidence limits in brackets.

One patient developed deep venous thrombosis verified by phlebography. Two patients had abnormal FUT but normal phlebography. The plasma level for D-dimer in the 15 patients with normal FUT was 500 ng/ml (300-800) preoperatively. The D-dimer level increased postoperatively to 1700 ng/ml (900-3300) (p < 0.001). The following days the D-dimer level increased steadily to 4800 ng/ml (2600-6800) 6 days postoperatively. The plasma level of D-dimer in the volunteers were less than 110 ng/ml both before and after injection of Logiparin. The plasma level of D-dimer in the patient with deep venous thrombosis and the 2 patients with abnormal FUT were within the range of the patients with normal FUT.

The postoperative D-dimer level was as high as that reported in patients with diagnosed thromboembolism.

In conclusion, the D-dimer test does not seem to be a potential screening test for postoperative thromboembolism.