Early Postoperative Venous Thromboembolism After Tumor Resection for Diffuse Gliomas: Diagnosis and Implications for Preventing Symptomatic Venous Thromboembolism.

Abstract

Patients undergoing glioma resection are at high risk for venous thromboembolism (VTE), making early diagnosis and prevention critical. This retrospective single-institutional cohort analysis investigated the incidence of VTE on postoperative day (POD) 1 after diffuse glioma resection, screening effectiveness of plasma soluble fibrin monomer complex (SFMC) and D-dimer levels, and management outcomes. A total of 81 patients who underwent diffuse glioma resection at our institution from 2021 to 2023 were analyzed. VTE was screened by D-dimer and SFMC levels on POD1 and diagnosed by enhanced computed tomography of the chest, abdomen, and lower extremities. Patients with asymptomatic VTE were managed with mechanical prevention, followed by anticoagulation therapy 1 week after craniotomy. Of the 81 patients, 33 (40.7%) were diagnosed with VTE; 31 were asymptomatic. D-dimer, SFMC, and their combination had positive predictive values of 83%, 68%, and 69%, respectively. SFMC measurement did not improve D-dimer false positives. Among 12 patients with false-negative D-dimer results, SFMC identified VTE in 3; all 3 had glioblastoma with 9 having other than glioblastoma. No asymptomatic cases progressed to symptomatic VTE. Asymptomatic VTE frequently developed on POD1 after diffuse glioma resection, but early diagnosis prevented progression. SFMC levels can improve VTE detection in glioblastoma patients.