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©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
possible role of soluble fibrin monomer complex after gastroenterological surgery
Masatoshi Kochi, Manabu Shimomura, Takao Hinoi, Hiroyuki Egi, Kazuaki Tanabe, Yasuyo Ishizaki, Tomohiro Adachi, Hirotaka Tashiro, Hideki Ohdan
Masatoshi Kochi, Hiroyuki Egi, Kazuaki Tanabe, Tomohiro Adachi, Hideki Ohdan, Department of Gastroenterological and Transplant Surgery, Applied Life Sciences, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima city, Hiroshima 734-8551, Japan
Manabu Shimomura, Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, Higashihiroshima City, Hiroshima 739-0041, Japan
Takao Hinoi, Hirotaka Tashiro, Department of Surgery, Institute for Clinical Research, National Hospital Organization Kure Medical Center and Chu-goku Cancer Center, Kure City, Hiroshima 737-0023, Japan
Yasuyo Ishizaki, Department of Surgery, National Hospital Organization Hiroshima-nishi Medical Center, Otake City, Hiroshima 739-0696, Japan
Author contributions: Shimomura M designed the study; Kochi M and Shimomura M analyzed and interpreted the data; Hinoi T, Egi H, Tanabe K, Ishizaki Y and Adachi T participated in this clinical study and treated the patients; Kochi M and Shimomura M wrote the paper; Ohdan H is the chief clinical investigator; all authors read and approved the final manuscript.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee of Hiroshima University Hospital.
Informed consent statement: All patients gave informed consent prior to study enrolment.
Conflict-of-interest statement: The authors have no potential conflicts of interest to disclose.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Manabu Shimomura, MD, PhD, Department of Surgery, National Hospital Organization Higashihiroshima Medical Center, 513 Jike, Saijyo-cho, Higashihiroshima City, Hiroshima 739-0041, Japan. manabus761215@gmail.com
Telephone: +81-82-4232176 Fax: +81-82-4224675
Received: November 15, 2016
Peer-review started: November 18, 2016
First decision: December 19, 2016
Revised: January 5, 2017
Accepted: March 2, 2017
Article in press: March 2, 2017
Published online: March 28, 2017
AIM
To examine the role of soluble fibrin monomer complex (SFMC) in the prediction of hypercoagulable state after gastroenterological surgery.
METHODS
We collected data on the clinical risk factors and fibrin-related makers from patients who underwent gastroenterological surgery at Hiroshima University Hospital between April 1, 2014 and March 31, 2015. We investigated the clinical significance of SFMC, which is known to reflect the early plasmatic activation of coagulation, in the view of these fibrin related markers.
RESULTS
A total of 123 patients were included in the present study. There were no patients with symptomatic VTE. Thirty-five (28%) patients received postoperative anticoagulant therapy. In the multivariate analysis, a high SFMC level on POD 1 was independently associated with D-dimer elevation on POD 7 (OR = 4.31, 95%CI: 1.10-18.30, P = 0.03). The cutoff SFMC level was 3.8 μg/mL (AUC = 0.78, sensitivity, 63%, specificity, 89%). The D-dimer level on POD 7 was significantly reduced in high-SFMC patients who received anticoagulant therapy in comparison to high-SFMC patients who did not.
CONCLUSION
The SFMC on POD 1 strongly predicted the hypercoagulable state after gastroenterological surgery than the clinical risk factors and the other fibrin related markers.
Core tip: We found that the plasma level of soluble fibrin monomer complex (SFMC) on POD 1 was more strongly associated with D-dimer elevation on POD 7 than were the clinical risk factors or other fibrin-related markers in 123 cases after gastroenterological surgery, suggesting the possible role of SFMC in the prediction of a hypercoagulable state and subsequent venous thromboembolism. The present study also demonstrated the possibility that the plasma levels of SFMC could be used as an indication for anticoagulant therapy in patients who have undergone gastroenterological surgery.
