The Predictive Value of d-Dimer Test for VenousThromboembolism During Puerperium: A Prospective Cohort Study

摘要

The aim of this study was to investigate the d-dimer for prediction ofvenous thromboembolism (VTE) events in puerperium and to identify other riskfactors associated with the occurrence of VTE. This was a prospectiveobservational cohort study, which included 16 127 women who gave birth after 28weeks of gestation at Women’s Hospital of Zhejiang University, School ofMedicine, from January 2016 to December 2016. Data including basic maternal andfetal characteristics, pregnancy complications, and predictive biomarkers withinpostpartum 24 hours including d-dimer, platelet, and fibrinogen werecollected for analyses. In the cohort study, 19 (0.12%) women were identified asVTE, including 1 pulmonary embolism event and 18 deep venous thrombosis events.The receiver operating characteristic curve analysis suggested the best cutoffpoint for d-dimer level within postpartum 24 hours was 3.695 mg/L, witha specificity of 75.5% and a sensitivity of 73.7%, and there was no statisticalcorrelation between fibrinogen and VTE, as well as between platelets and VTE. Onmultivariate analysis, age ≥35 years (odds ratio [OR] = 2.895, 95% confidenceinterval [CI]: 1.079-7.773), scarred uterus (OR = 3.894, 95% CI: 1.234-12.282),intrauterine infection (OR = 7.214, 95% CI: 1.519-34.262), antiphospholipidsyndrome (OR = 199.530, 95% CI: 15.152-2627.529), d-dimer ≥3.70 mg/L(OR = 7.573, 95% CI: 2.699-21.247), and emergency cesarean delivery (OR =23.357, 95% CI: 2.819-193.508) were independently associated with VTE inpuerperium. We concluded that d-dimer ≥3.70 mg/L was an independentpredictor of VTE during puerperium and d-dimer testing was necessaryfor perinatal women.