ORIGINAL RESEARCH article
Front. Med.
Sec. Geriatric Medicine
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1623198
Elderly patients undergoing laparoscopic radical cystectomy benefit from dynamic D-dimer measurement in combination with vascular ultrasonography: reduction of VTE risk and improvement of clinical outcomes
Provisionally accepted
- 1Yinzhou No.2 Hospital, Ningbo, China
- 2Department of Urology, Ningbo urology and nephrology, Ningbo, China
- 3Ningbo urology and nephrolog, Ningbo, China
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Venous thromboembolism (VTE) is serious in elderly patients undergoing laparoscopic radical cystectomy and bilateral pelvic lymph node dissection. We compared the results of two VTE prophylaxis protocols: dynamic D-dimer measurement in combination with ultrasonography screening in Experimental Group (EG), and conventional VTE prophylaxis in Historical Control Group (HCG).Between January 2022 and January 2024, the elderly patients undergoing such surgeries in EG received dynamic measurement of plasma D-dimer at admission and at 1, 3, 7, and 14 days after surgery in combination with ultrasonography screening, and commensurate VTE mechanical prophylaxis measures. Between January 2019 and December 2021, elderly patients in HCG underwent conventional prophylaxis and mechanical measures. And they were observed carefully for VTE symptoms, with Doppler ultrasonography being performed only in patients with clinical suspicion for VTE. The incidence of VTE event, major postoperative complications, major bleeding rate, and evaluation of activities of daily living within 30 days postoperatively were compared.The preoperative and intraoperative parameters were similar between the two groups. In EG, dynamic D-dimer measurements revealed a distinct temporal declining pattern. In HCG, VTE was detected in 5 patients out of 98 patients (5/98, 4.08%); and in EG, 8 patients were found to have DVT (8/109, 7.34%) (p=0.04). The incidence of symptomatic VTE was significantly lower in EG than in HCG (1 and 5 cases respectively, 0.9% vs. 5.1%, p=0.04), and the incidence of postoperative asymptomatic VTE was higher in the EG than in the HCG (7 and 0 cases respectively, 6.4% vs. 0).The incidence of major complications was similar between the two groups (p=0.61). The average Barthel Index score in EG was 81.0 points, significantly higher than 78.3 points of the HCG (p=0.03), and the result demonstrated a faster recovery of activities of daily living in the Experimental Group.Our results demonstrated that postoperative dynamic D-dimer and ultrasonography measurement in elderly patients can better monitor the risk of VTE, identify asymptomatic thrombosis at an early stage, optimize the timing of intervention and improve clinical outcomes, without resulting in more complications or major bleeding. Elderly patients undergoing laparoscopic radical cystectomy could benefit from such strategies.
Keywords: Bladder cancer, Cystectomy, Thromboembolism, d-dimer, screening
Received: 07 May 2025; Accepted: 20 Jun 2025.
Copyright: © 2025 Gao, Ye and Xu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wenbo Gao, Yinzhou No.2 Hospital, Ningbo, China
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