Early D-Dimer Screening for Pulmonary Vein Stump Thrombosis After Lung Lobectomy

To address the risk of cerebral infarction from pulmonary vein stump thrombosis (PVST) after lung lobectomy, this study evaluated D-dimer measurement as an early screening tool, given that routine contrast-enhanced computed tomography is impractical.

We retrospectively reviewed 198 patients who underwent lung lobectomy and postoperative contrast-enhanced computed tomography between January 2021 and August 2024. D-dimer levels were measured on postoperative day 1. Receiver operating characteristic curve analysis evaluated D-dimer's discriminative ability, and multivariable logistic regression identified independent risk factors for PVST, which were diagnosed on postoperative days 5 to 7 by computed tomography.

PVST was detected in 38 of 198 patients (19.2%), typically associated with left upper lobectomy and long pulmonary vein stumps. Postoperative day 1 D-dimer levels were significantly higher in the thrombosis-positive group (median, 1.8 vs 1.3 μg/mL; P < .001) but did not correlate with thrombus volume. Receiver operating characteristic analysis yielded an area under the curve of 0.692; a negative cutoff of 1.2 μg/mL provided a negative predictive value of 96.9%. Multivariable analysis identified 3 independent predictors for thrombosis: interstitial pneumonia, left upper lobectomy, and postoperative day 1 D-dimer level ≥1.2 μg/mL. Overall postoperative complication rates and postoperative hospital duration were similar, although several complications were more frequent in the thrombosis-positive group. Cerebral infarction occurred in 4 patients (1.6%).

D-dimer measurement on postoperative day 1 shows promise for preliminary PVST screening. However, our single-center retrospective findings require prospective multicenter validation before the 1.2 μg/mL cutoff is implemented in routine practice.