{"paper_id":"19c1384b-c084-41e8-8a1c-72ec68024a98","body_text":"Preoperative prevalence and risk factors of venous thromboembolism in patients with breast cancer: A retrospective cohort analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Preoperative prevalence and risk factors of venous thromboembolism in patients with breast cancer: A retrospective cohort analysis Takaaki Fujii, Erika Suzuki, Saya Abeta, Risa Murasato, Hiroyuki Takei This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8409774/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 17 You are reading this latest preprint version Abstract Background Although venous thromboembolism (VTE) is a serious perioperative complication in cancer patients, its preoperative prevalence and predictors in breast cancer (BC) remain insufficiently defined. With the increasing incidence of BC worldwide and the aging population in Japan, elderly patients with BC represent a growing subgroup at risk of VTE. Patients and Methods: We retrospectively analyzed the cases of 313 consecutive patients with BC who underwent breast surgery and preoperative evaluation at our institution. Clinical characteristics including age, comorbidities, and D-dimer level were collected. All of the patentis underwent imaging for the identification of VTE. We performed univariable and multivariable logistic regression analyses to identify predictors of VTE. Results Preoperative VTE was detected in 22 patients (7.0%). All cases were asymptomatic, and included pulmonary embolism (n = 1, 0.3%), proximal deep vein thrombosis (n = 2, 0.6%), and distal thrombosis (n = 20, 6.4%). In the univariable analysis, age ≥ 70 years (p < 0.001) and D-dimer ≥ 1 µg/mL (p < 0.001) were significantly associated with VTE, and hypertension showed a marginal association. Age ≥ 70 years and D-dimer ≥ 1 µg/mL remained an independent predictor. Predicted probabilities were negligible in the patients < 70 years, ~ 8% in those ≥ 70 years with normal D-dimer, and ~ 26% in those ≥ 70 years with elevated D-dimer. No patient experienced postoperative progression of VTE or a new pulmonary embolism. Conclusions Preoperative VTE was not uncommon in this BC series, particularly among the elderly patients with older age and elevated D-dimer. The combination of age and D-dimer provided a simple and practical method for perioperative risk stratification. Targeted screening and management of high-risk patients may enhance surgical safety. Larger multicenter studies are warranted to validate this strategy. breast cancer venous thromboembolism VTE D-dimer elderly patients preoperative risk stratification INTRODUCTION Breast cancer is the most common malignancy among women worldwide, and its incidence continues to rise [ 1 ]. In Japan, this trend is accompanied by the rapid aging of the population, resulting in an increasing proportion of elderly patients with breast cancer [ 2 ]. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major complication in cancer patients. The incidence of VTE, particularly PE, has been reported to be increased in elderly cancer patients compared to younger cancer patients [ 3 – 5 ]. Although breast cancer has been considered a relatively low-risk malignancy for VTE compared to gastrointestinal and gynecologic cancers, registry data and clinical studies suggest that breast cancer patients, particularly those who are elderly, are at higher risk of experiencing a VTE [ 4 – 10 ]. The Japanese Cancer-VTE Registry described a non-negligible prevalence of baseline VTE, with factors such as older age and elevated D-dimer identified as significant predictors [ 4 , 8 , 11 ]. D-dimer is widely used as a diagnostic biomarker for the exclusion of VTE [ 12 ] and has also been investigated as a prognostic marker in breast cancer itself [ 13 , 14 ], underscoring its biological and clinical relevance in this patient population. However, the data focusing on the prevalence and risk factors of preoperative VTE in breast cancer patients remain limited. Given the high proportion of elderly patients treated at our institution, we conducted a retrospective analysis to ( i ) clarify the prevalence of preoperative VTE in elderly patients with breast cancer and ( ii ) explore clinical and laboratory predictors of VTE in this population, with particular emphasis on age and D-dimer. PATIENTS AND METHODS We retrospectively analyzed the cases of the 313 consecutive breast cancer patients who underwent a preoperative evaluation and breast surgery at the Department of Breast Surgery and Oncology, Nippon Medical School Chiba Hokusoh Hospital (Chiba, Japan) during the period from January 2022 through August 2025. The data collected for this study included age, body mass index (BMI), cancer stage, estrogen receptor (ER) status, progesterone receptor (PgR) status, HER2 status, neoadjuvant chemotherapy (NAC), comorbidities (hypertension, hyperlipidemia, diabetes), anticoagulant use, and the D-dimer level. D-dimer had been measured in 229 patients (73.2%). A preoperative lower-extremity ultrasound examinations had been performed for each patients to investigate the presence of VTE. Contrast-enhanced computed tomography (CT) was used to investigate the possible presence of a pulmonary embolism (PE). Patients with positive VTE findings were referred to the hospital’s Department of Cardiology. For the patients with a PE or proximal deep vein thrombosis (DVT), the administration of a direct-acting oral anticoagulants (DOACs) was considered prior to the surgery. We conducted a univariable analysis using Fisher’s exact test or the χ 2 -test. Differences were considered significant when the p-value was < 0.05. A logistic regression analysis was performed to identify predictors of VTE. Based on the univariable results and clinical relevance, we further analyzed age ≥ 70 years and D-dimer ≥ 1 µg/mL. In addition, the predicted probabilities were calculated for representative risk combinations. RESULTS The patients’ baseline characteristics are summarized in Table 1 . The median age was 66 years (range 33–92 yrs), and the median BMI was 23.0. Forty-two patients (13.4%) received neoadjuvant chemotherapy. Nineteen patients (6.1%) had undergone anticoagulant therapy prior to their cancer diagnosis. The following were also observed: hypertension (n = 103 patients, 32.9%), hyperlipidemia (n = 72, 23.0%), and diabetes mellitus (n = 32, 10.2%). Elevated D-dimer levels were observed in 38 cases (12.1%) of the 229 cases in which the D-dimer level had been determined. Preoperative VTE was diagnosed in 22 patients (7.0%); all were asymptomatic. The distribution of PE and DVT cases are summarized in Table 2 . Pulmonary embolism was identified in one patient, and a proximal DVT was identified in two patients; a DOAC was administered preoperatively in each case. Table 1 Clinical characteristics of patients with breast cancer (n = 313) All cases n = 313 Age (y.o., median (range)) 66 (33–92) BMI (median (range)) 23.0 (13.4–39.8) Stage (n (%)) 0 34 (10.9) Ⅰ 140 (44.7) Ⅱ 119 (38.0) Ⅲ 17 (5.4) Ⅳ 3 (1.0) ER (positive, n (%)) 257 (82.1) PgR (positive, n (%)) 232 (74.1) HER2 (positive, n (%)) 40 (12.8) NAC (n (%)) 42 (13.4) Anticoagrant therapy (n (%)) 19 (6.1) Hypertension (n (%)) 103 (32.9) Hyperlipidemia (n (%)) 72 (23.0) Diabetes (n (%)) 32 (10.2) D-dimer (1≦, n (%))* 38 (12.1) BMI; body mass index, NAC; neoadjuvant chemotherapy. * Measured in 229 cases. Table 2 Summary of VTE prevalence at surgery among patients with breast cancer (n = 313) Total Symptomatic Asymptomatic All VTE (n (%)) 22 (7.0) 0 22 (7.0) PE (with/without DVT, n (%)) 1 (0.3) 0 1 (0.3) DVT (with/without PE, n (%)) 22 (7.0) 0 22 (7.0) Proximal DVT 2 (0.6) 0 2 (0.6) Distal DVT 20 (6.4) 0 20 (6.4) DVT; deep vein thrombosis, PE; pulmonary embolism, VTE; venous thromboembolism. Table 3 shows the results of the univariate analysis by the presence or absence of VTE for the risk factor analysis. Age ≥ 70 years (p < 0.001) and D-dimer ≥ 1 µg/mL (p < 0.001) were significantly associated with VTE, and hypertension showed a borderline association. In the multivariate analysis, Age ≥ 70 years (odds ratio 6.330, 95% confidence interval 1.683–23.813, p = 0.006) and D-dimer ≥ 1 µg/mL (odds ratio 4.904, 95% confidence interval 1.699–14.153, p = 0.003) remained independent predictors. Table 4 provides the predicted probabilities of VTE according to age and D-dimer level. The VTE risk was negligible in the younger patients, ~ 8% in the elderly patients with a normal D-dimer level (< 1 µg/mL), and ~ 26% in elderly patients with an elevated D-dimer level. No patient developed postoperative progression of VTE or PE. Table 3 Univariable analysis of background factors associated with VTE prevalence (n = 313) VTE cases non-VTE cases P n = 22 n = 291 Age (70≦, n (%)) 19 (86.4) 116 (39.9) < 0.001 BMI (25≦, n (%)) 6 (27.3) 75 (25.8) 0.877 Stage (n (%)) 0.407 0 2 (9.1) 32 (11.0) Ⅰ 8 (36.4) 132 (45.4) Ⅱ 10 (45.5) 100 (34.4) Ⅲ 1 (4.5) 16 (5.5) Ⅳ 1 (4.5) 2 (0.7) ER (positive, n (%)) 19 238 0.776 PgR (positive, n (%)) 16 216 0.806 HER2 (positive, n (%)) 3 37 0.751 NAC (n (%)) 5 (22.7) 37 (12.7) 0.193 Anticoagrant therapy (n (%)) 2 (9.1) 17 (5.8) 0.633 Hypertension (n (%)) 11 (50.0) 92 (31.6) 0.099 Hyperlipidemia (n (%)) 8 (36.4) 64 (22.0) 0.185 Diabetes (n (%)) 2 (9.1) 30 (10.3) 1.000 D-dimer (1≦, n (%))* 10 (55.6) 28 (13.2) < 0.001 VTE; venous thromboembolism, BMI; body mass index, NAC; neoadjuvant chemotherapy. * Measured in 229 cases. Table 4 Predicted probability of VTE according to age and D-dimer status. Age D-dimer Predicted VTE probability (%) < 70 years < 1 µg/mL < 1 < 70 years ≥ 1 µg/mL ~ 2 ≥ 70 years < 1 µg/mL ~ 8 ≥ 70 years ≥ 1 µg/mL ~ 26 VTE; venous thromboembolism. DISCUSSION Although the incidence of VTE has not been considered particularly high among patients with breast cancer, our present analyses revealed that a preoperative VTE occurred in 7.0% of breast cancer patients prior to surgery, which is a higher rate than the 2.0% reported in Japan’s Cancer-VTE Registry [ 8 ]. This discrepancy may reflect the older age of our study population, as the 7.0% rate observed herein is consistent with reports of an increased VTE risk among elderly breast cancer patients [ 3 – 5 , 7 ]. The median age of the present patients was 66 years, representing an older cohort than the median age of 58.4 years in the Cancer-VTE Registry [ 8 ]. The universal use of preoperative ultrasonography and the higher age distribution in our cohort likely contributed to the increased detection of VTE. However, no postoperative VTE progression occurred in this cohort, which is consistent with reports that breast cancer surgery poses a relatively low postoperative VTE risk [ 15 ]. It is also likely that preoperative screening and cardiology co-management, including DOAC initiation when indicated, contributed to the safe outcomes in our patients. The identification of a preoperative VTE has an additional clinical implication: in patients with a confirmed VTE, the perioperative use of mechanical prophylaxis such as foot pumps can be avoided, thereby reducing the risk of thrombus mobilization and embolism [ 16 ]. Instead, individualized anticoagulation strategies may be applied. Screening therefore not only enables the diagnosis of VTE but also optimizes intraoperative and postoperative VTE prevention strategies tailored to the patient’s condition. Notably, the use of routine pharmacological prophylaxis remains controversial in breast surgery, given the increased hematoma risk it poses without a clear reduction in the risk of VTE [ 17 ]. D-dimer emerged as a key predictor of VTE in the present study’s population, aligning with prior evidence of its predictive value in cancer-associated VTE [ 8 , 12 , 13 ]. Various models have been developed to predict thrombosis based on multiple risk factors [ 3 – 6 ]; however, the simple combination of age and D-dimer applied in the present study can stratify preoperative breast cancer patients into negligible- and high-risk groups, supporting tailored imaging and management strategies. Confirming the presence of VTE preoperatively enables safer, individualized perioperative care by avoiding the use of routine preventive measures (such as foot pumps) that may be harmful to patients with DVT [ 16 ]. Our findings support selective rather than universal prophylaxis, focusing on elderly patients with elevated D-dimer. The validation of our findings in larger multicenter cohorts is needed, and the optimization of outcomes in an aging breast cancer population could be enhanced by the integration of this risk stratification into perioperative care pathways. This study also underscores the importance of multidisciplinary team (MDT) care. Collaborations among breast surgeons, anesthesiologists, radiologists, and cardiologists ensured that the patients with preoperative VTE who treated at our hospital were appropriately anticoagulated and safely managed throughout the perioperative period. MDT approaches have been confirmed to improve cancer-associated VTE outcomes [ 18 , 19 ]. Investigations of D-dimer beyond its use for the prediction of VTE have been informative. For example, studies specific to breast cancer suggested that D-dimer may function as a prognostic marker and monitoring tool in patients undergoing systemic therapy [ 13 , 14 ]. In the present study, the short observation period made prognostic analyses difficult, necessitating further investigations. Our findings support the role of D-dimer not only in ruling out VTE but also as a biologically meaningful marker in breast cancer. Not all cases with relatively elevated D-dimer levels have a confirmed VTE, and the significance of elevated D-dimer levels requires further investigation. This study has several limitations. It was a single-center retrospective study with a relatively small number of VTE events, limiting the generalizability of the results. In addition, D-dimer was not measured in all patients, which may have introduced selection bias. However, this investigation of a population with a high proportion of elderly patients is highly valuable. Finally, although the findings are hypothesis-generating, prospective multicenter studies are required to validate the predictive roles of age and D-dimer in this setting. In conclusion, preoperative VTE was not uncommon (7.0%) in this series of breast cancer patients, particularly in the elderly individuals. Elevated D-dimer and older age were independent predictors of VTE, and its combination allowed a simple risk stratification. Targeted screening and multidisciplinary perioperative management may enhance the safety of breast cancer surgery. Abbreviations BC breast cancer VTE Venous thromboembolism DVT deep vein thrombosis PE pulmonary embolism BMI body mass index NAC neoadjuvant chemotherapy CT Contrast-enhanced computed tomography DOAC direct-acting oral anticoagulant ER estrogen receptor PgR progesterone receptor. Declarations Ethics approval and consent to participate This retrospective observational study was conducted in accordance with the ethical standards of the Clinical Ethics Committee of Nippon Medical School (approval No. M-2025-396) and the Declaration of Helsinki and its later amendments. The study used existing clinical information obtained during routine care. The Clinical Ethics Committee waived the requirement for written informed consent, and patients were provided with an opportunity to refuse participation via an opt-out procedure in accordance with the Japanese ethical guidelines via our institutional website and notice board. Data were de-identified prior to analysis. Consent for publication Not applicable Competing Interests The authors have no conflicts of interest to declare. Funding Not applicable/ No funding was received. Author Contribution TF analyzed the data and wrote the initial draft of the manuscript. ES, SA, and RM collected the data and were involved in the initial study conception and design. TF, ES, SA, RM, and HT were involved in drafting and revising the manuscript. All authors have read and approved the final manuscript. Acknowledgements We thank the radiologists and cardiologists at Nippon Medical School Chiba Hokusoh Hospital for their cooperation. Data Availability The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. References Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin. 2024;74(3):229–63. 10.3322/caac.21834 . Iwamoto T, Kumamaru H, Niikura N, Sagara Y, Miyashita M, Konishi T, Sanuki N, Tanakura K, Nagahashi M, Hayashi N, Yoshida M, Watanabe C, Kinukawa N, Toi M, Saji S. 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How to treat venous thromboembolism (TVE) in cancer patients: ten years of multidisciplinary team meetings (MDTM) at Saint-Louis Hospital. J Med Vasc. 2020;45(6S): 6S24-6S30. 10.1016/S2542-4513(20)30516-2 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 02 Apr, 2026 Reviews received at journal 21 Mar, 2026 Reviews received at journal 20 Mar, 2026 Reviews received at journal 11 Mar, 2026 Reviews received at journal 08 Mar, 2026 Reviews received at journal 26 Feb, 2026 Reviewers agreed at journal 24 Feb, 2026 Reviewers agreed at journal 21 Feb, 2026 Reviewers agreed at journal 21 Feb, 2026 Reviewers agreed at journal 19 Feb, 2026 Reviewers agreed at journal 19 Feb, 2026 Reviewers agreed at journal 19 Feb, 2026 Reviewers invited by journal 19 Feb, 2026 Editor assigned by journal 01 Jan, 2026 Editor invited by journal 24 Dec, 2025 Submission checks completed at journal 24 Dec, 2025 First submitted to journal 24 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-8409774\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":false,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":594997689,\"identity\":\"b8278e74-2a7c-4304-aa33-b6cc858d68fd\",\"order_by\":0,\"name\":\"Takaaki Fujii\",\"email\":\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA10lEQVRIiWNgGAWjYBAC9gYGBkYgNmADsSDgAH4tPAeYoVp44CqJ1cIgkUCkw3gY+A9+nFFjZ8wn+fboxh8MdvIMjGfxW8PDwMwsueFYshmbdF7abR6GZMMGhnP47bOXf8wg+YCN2YZNOsfsNgMDM1D5GQOCtvx88K/ehk3yjNnNHwz1RGlhk9zYdtiMTYLH7AYPw2GitJhZzuw7bszGA3QYj8FxwzZCfuFhYHx8s+dbteH8dpDDKqrl+SUIhBgaADqJTeIMKTrAgL+HZC2jYBSMglEwvAEAchA91v/UN0sAAAAASUVORK5CYII=\",\"orcid\":\"\",\"institution\":\"Nippon Medical School\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Takaaki\",\"middleName\":\"\",\"lastName\":\"Fujii\",\"suffix\":\"\"},{\"id\":594997690,\"identity\":\"8c508edc-ed33-48e1-9b4f-b9e7d467e667\",\"order_by\":1,\"name\":\"Erika Suzuki\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Nippon Medical School\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Erika\",\"middleName\":\"\",\"lastName\":\"Suzuki\",\"suffix\":\"\"},{\"id\":594997691,\"identity\":\"50860895-3d26-4daa-97e0-6f961aea3bc1\",\"order_by\":2,\"name\":\"Saya Abeta\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Nippon Medical School\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Saya\",\"middleName\":\"\",\"lastName\":\"Abeta\",\"suffix\":\"\"},{\"id\":594997692,\"identity\":\"a5d5ecdc-d3fb-4d65-982c-f24825d09208\",\"order_by\":3,\"name\":\"Risa Murasato\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Nippon Medical School\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Risa\",\"middleName\":\"\",\"lastName\":\"Murasato\",\"suffix\":\"\"},{\"id\":594997693,\"identity\":\"b88c0cfb-747f-43dd-8268-c950328a5ec4\",\"order_by\":4,\"name\":\"Hiroyuki Takei\",\"email\":\"\",\"orcid\":\"\",\"institution\":\"Nippon Medical School\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Hiroyuki\",\"middleName\":\"\",\"lastName\":\"Takei\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-12-20 05:53:31\",\"currentVersionCode\":1,\"declarations\":\"\",\"doi\":\"10.21203/rs.3.rs-8409774/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-8409774/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":103505327,\"identity\":\"94e51639-c56d-40dd-9fff-6095455a963e\",\"added_by\":\"auto\",\"created_at\":\"2026-02-26 13:29:58\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":549341,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-8409774/v1/84a956b4-72dc-4a92-8e93-de4e00d5ad58.pdf\"}],\"financialInterests\":\"No competing interests reported.\",\"formattedTitle\":\"Preoperative prevalence and risk factors of venous thromboembolism in patients with breast cancer: A retrospective cohort analysis\",\"fulltext\":[{\"header\":\"INTRODUCTION\",\"content\":\"\\u003cp\\u003eBreast cancer is the most common malignancy among women worldwide, and its incidence continues to rise [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. In Japan, this trend is accompanied by the rapid aging of the population, resulting in an increasing proportion of elderly patients with breast cancer [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a major complication in cancer patients. The incidence of VTE, particularly PE, has been reported to be increased in elderly cancer patients compared to younger cancer patients [\\u003cspan additionalcitationids=\\\"CR4\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eAlthough breast cancer has been considered a relatively low-risk malignancy for VTE compared to gastrointestinal and gynecologic cancers, registry data and clinical studies suggest that breast cancer patients, particularly those who are elderly, are at higher risk of experiencing a VTE [\\u003cspan additionalcitationids=\\\"CR5 CR6 CR7 CR8 CR9\\\" citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e]. The Japanese Cancer-VTE Registry described a non-negligible prevalence of baseline VTE, with factors such as older age and elevated D-dimer identified as significant predictors [\\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eD-dimer is widely used as a diagnostic biomarker for the exclusion of VTE [\\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e] and has also been investigated as a prognostic marker in breast cancer itself [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e], underscoring its biological and clinical relevance in this patient population. However, the data focusing on the prevalence and risk factors of preoperative VTE in breast cancer patients remain limited. Given the high proportion of elderly patients treated at our institution, we conducted a retrospective analysis to (\\u003cem\\u003ei\\u003c/em\\u003e) clarify the prevalence of preoperative VTE in elderly patients with breast cancer and (\\u003cem\\u003eii\\u003c/em\\u003e) explore clinical and laboratory predictors of VTE in this population, with particular emphasis on age and D-dimer.\\u003c/p\\u003e\"},{\"header\":\"PATIENTS AND METHODS\",\"content\":\"\\u003cp\\u003eWe retrospectively analyzed the cases of the 313 consecutive breast cancer patients who underwent a preoperative evaluation and breast surgery at the Department of Breast Surgery and Oncology, Nippon Medical School Chiba Hokusoh Hospital (Chiba, Japan) during the period from January 2022 through August 2025. The data collected for this study included age, body mass index (BMI), cancer stage, estrogen receptor (ER) status, progesterone receptor (PgR) status, HER2 status, neoadjuvant chemotherapy (NAC), comorbidities (hypertension, hyperlipidemia, diabetes), anticoagulant use, and the D-dimer level. D-dimer had been measured in 229 patients (73.2%).\\u003c/p\\u003e \\u003cp\\u003eA preoperative lower-extremity ultrasound examinations had been performed for each patients to investigate the presence of VTE. Contrast-enhanced computed tomography (CT) was used to investigate the possible presence of a pulmonary embolism (PE). Patients with positive VTE findings were referred to the hospital\\u0026rsquo;s Department of Cardiology. For the patients with a PE or proximal deep vein thrombosis (DVT), the administration of a direct-acting oral anticoagulants (DOACs) was considered prior to the surgery.\\u003c/p\\u003e \\u003cp\\u003eWe conducted a univariable analysis using Fisher\\u0026rsquo;s exact test or the χ\\u003csup\\u003e2\\u003c/sup\\u003e-test. Differences were considered significant when the p-value was \\u0026lt;\\u0026thinsp;0.05. A logistic regression analysis was performed to identify predictors of VTE. Based on the univariable results and clinical relevance, we further analyzed age\\u0026thinsp;\\u0026ge;\\u0026thinsp;70 years and D-dimer\\u0026thinsp;\\u0026ge;\\u0026thinsp;1 \\u0026micro;g/mL. In addition, the predicted probabilities were calculated for representative risk combinations.\\u003c/p\\u003e\"},{\"header\":\"RESULTS\",\"content\":\"\\u003cp\\u003eThe patients\\u0026rsquo; baseline characteristics are summarized in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e. The median age was 66 years (range 33\\u0026ndash;92 yrs), and the median BMI was 23.0. Forty-two patients (13.4%) received neoadjuvant chemotherapy. Nineteen patients (6.1%) had undergone anticoagulant therapy prior to their cancer diagnosis. The following were also observed: hypertension (n\\u0026thinsp;=\\u0026thinsp;103 patients, 32.9%), hyperlipidemia (n\\u0026thinsp;=\\u0026thinsp;72, 23.0%), and diabetes mellitus (n\\u0026thinsp;=\\u0026thinsp;32, 10.2%). Elevated D-dimer levels were observed in 38 cases (12.1%) of the 229 cases in which the D-dimer level had been determined. Preoperative VTE was diagnosed in 22 patients (7.0%); all were asymptomatic. The distribution of PE and DVT cases are summarized in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab2\\\" class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e. Pulmonary embolism was identified in one patient, and a proximal DVT was identified in two patients; a DOAC was administered preoperatively in each case.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eClinical characteristics of patients with breast cancer (n\\u0026thinsp;=\\u0026thinsp;313)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eAll cases\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;313\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge (y.o., median (range))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e66 (33\\u0026ndash;92)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI (median (range))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e23.0 (13.4\\u0026ndash;39.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStage (n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e34 (10.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eⅠ\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e140 (44.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eⅡ\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e119 (38.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eⅢ\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e17 (5.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eⅣ\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3 (1.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eER (positive, n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e257 (82.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePgR (positive, n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e232 (74.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHER2 (positive, n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e40 (12.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNAC (n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e42 (13.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnticoagrant therapy (n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19 (6.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHypertension (n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e103 (32.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHyperlipidemia (n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e72 (23.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiabetes (n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e32 (10.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eD-dimer (1≦, n (%))*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e38 (12.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"2\\\"\\u003eBMI; body mass index, NAC; neoadjuvant chemotherapy. * Measured in 229 cases.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eSummary of VTE prevalence at surgery among patients with breast cancer (n\\u0026thinsp;=\\u0026thinsp;313)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTotal\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003eSymptomatic\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003eAsymptomatic\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAll VTE (n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22 (7.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e22 (7.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePE (with/without DVT, n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (0.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1 (0.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDVT (with/without PE, n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e22 (7.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e22 (7.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eProximal DVT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (0.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e2 (0.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDistal DVT\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e20 (6.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e20 (6.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003eDVT; deep vein thrombosis, PE; pulmonary embolism, VTE; venous thromboembolism.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003eTable\\u0026nbsp;\\u003cspan refid=\\\"Tab3\\\" class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e shows the results of the univariate analysis by the presence or absence of VTE for the risk factor analysis. Age\\u0026thinsp;\\u0026ge;\\u0026thinsp;70 years (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) and D-dimer\\u0026thinsp;\\u0026ge;\\u0026thinsp;1 \\u0026micro;g/mL (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) were significantly associated with VTE, and hypertension showed a borderline association. In the multivariate analysis, Age\\u0026thinsp;\\u0026ge;\\u0026thinsp;70 years (odds ratio 6.330, 95% confidence interval 1.683\\u0026ndash;23.813, p\\u0026thinsp;=\\u0026thinsp;0.006) and D-dimer\\u0026thinsp;\\u0026ge;\\u0026thinsp;1 \\u0026micro;g/mL (odds ratio 4.904, 95% confidence interval 1.699\\u0026ndash;14.153, p\\u0026thinsp;=\\u0026thinsp;0.003) remained independent predictors. Table\\u0026nbsp;\\u003cspan refid=\\\"Tab4\\\" class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e provides the predicted probabilities of VTE according to age and D-dimer level. The VTE risk was negligible in the younger patients, ~\\u0026thinsp;8% in the elderly patients with a normal D-dimer level (\\u0026lt;\\u0026thinsp;1 \\u0026micro;g/mL), and ~\\u0026thinsp;26% in elderly patients with an elevated D-dimer level. No patient developed postoperative progression of VTE or PE.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab3\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 3\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003eUnivariable analysis of background factors associated with VTE prevalence (n\\u0026thinsp;=\\u0026thinsp;313)\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"4\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"char\\\" char=\\\".\\\" class=\\\"colspec\\\" colname=\\\"c4\\\" colnum=\\\"4\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e\\u0026nbsp;\\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eVTE cases\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003enon-VTE cases\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c4\\\" morerows=\\\"1\\\" rowspan=\\\"2\\\"\\u003e \\u003cp\\u003eP\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;22\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003en\\u0026thinsp;=\\u0026thinsp;291\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge (70≦, n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19 (86.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e116 (39.9)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eBMI (25≦, n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e6 (27.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e75 (25.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.877\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eStage (n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.407\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e0\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (9.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e32 (11.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eⅠ\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8 (36.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e132 (45.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eⅡ\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10 (45.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e100 (34.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eⅢ\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (4.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e16 (5.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eⅣ\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e1 (4.5)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e2 (0.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c4\\\"\\u003e\\u0026nbsp;\\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eER (positive, n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e19\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e238\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.776\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003ePgR (positive, n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e16\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e216\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.806\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHER2 (positive, n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e3\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e37\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.751\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eNAC (n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e5 (22.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e37 (12.7)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.193\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAnticoagrant therapy (n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (9.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e17 (5.8)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.633\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHypertension (n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e11 (50.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e92 (31.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.099\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eHyperlipidemia (n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e8 (36.4)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e64 (22.0)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e0.185\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDiabetes (n (%))\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e2 (9.1)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e30 (10.3)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e1.000\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eD-dimer (1≦, n (%))*\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e10 (55.6)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e28 (13.2)\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"char\\\" char=\\\".\\\" colname=\\\"c4\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;0.001\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003eVTE; venous thromboembolism, BMI; body mass index, NAC; neoadjuvant chemotherapy.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"4\\\"\\u003e* Measured in 229 cases.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab4\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 4\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePredicted probability of VTE according to age and D-dimer status.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"3\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c3\\\" colnum=\\\"3\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eAge\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eD-dimer\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003ePredicted VTE probability (%)\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;70 years\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;1 \\u0026micro;g/mL\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;1\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;70 years\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;1 \\u0026micro;g/mL\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e~\\u0026thinsp;2\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;70 years\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026lt;\\u0026thinsp;1 \\u0026micro;g/mL\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e~\\u0026thinsp;8\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;70 years\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e\\u0026ge;\\u0026thinsp;1 \\u0026micro;g/mL\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c3\\\"\\u003e \\u003cp\\u003e~\\u0026thinsp;26\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003ctfoot\\u003e \\u003ctr\\u003e\\u003ctd colspan=\\\"3\\\"\\u003eVTE; venous thromboembolism.\\u003c/td\\u003e\\u003c/tr\\u003e \\u003c/tfoot\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\"},{\"header\":\"DISCUSSION\",\"content\":\"\\u003cp\\u003eAlthough the incidence of VTE has not been considered particularly high among patients with breast cancer, our present analyses revealed that a preoperative VTE occurred in 7.0% of breast cancer patients prior to surgery, which is a higher rate than the 2.0% reported in Japan\\u0026rsquo;s Cancer-VTE Registry [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. This discrepancy may reflect the older age of our study population, as the 7.0% rate observed herein is consistent with reports of an increased VTE risk among elderly breast cancer patients [\\u003cspan additionalcitationids=\\\"CR4\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e]. The median age of the present patients was 66 years, representing an older cohort than the median age of 58.4 years in the Cancer-VTE Registry [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e]. The universal use of preoperative ultrasonography and the higher age distribution in our cohort likely contributed to the increased detection of VTE. However, no postoperative VTE progression occurred in this cohort, which is consistent with reports that breast cancer surgery poses a relatively low postoperative VTE risk [\\u003cspan citationid=\\\"CR15\\\" class=\\\"CitationRef\\\"\\u003e15\\u003c/span\\u003e]. It is also likely that preoperative screening and cardiology co-management, including DOAC initiation when indicated, contributed to the safe outcomes in our patients.\\u003c/p\\u003e \\u003cp\\u003eThe identification of a preoperative VTE has an additional clinical implication: in patients with a confirmed VTE, the perioperative use of mechanical prophylaxis such as foot pumps can be avoided, thereby reducing the risk of thrombus mobilization and embolism [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. Instead, individualized anticoagulation strategies may be applied. Screening therefore not only enables the diagnosis of VTE but also optimizes intraoperative and postoperative VTE prevention strategies tailored to the patient\\u0026rsquo;s condition. Notably, the use of routine pharmacological prophylaxis remains controversial in breast surgery, given the increased hematoma risk it poses without a clear reduction in the risk of VTE [\\u003cspan citationid=\\\"CR17\\\" class=\\\"CitationRef\\\"\\u003e17\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eD-dimer emerged as a key predictor of VTE in the present study\\u0026rsquo;s population, aligning with prior evidence of its predictive value in cancer-associated VTE [\\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. Various models have been developed to predict thrombosis based on multiple risk factors [\\u003cspan additionalcitationids=\\\"CR4 CR5\\\" citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]; however, the simple combination of age and D-dimer applied in the present study can stratify preoperative breast cancer patients into negligible- and high-risk groups, supporting tailored imaging and management strategies. Confirming the presence of VTE preoperatively enables safer, individualized perioperative care by avoiding the use of routine preventive measures (such as foot pumps) that may be harmful to patients with DVT [\\u003cspan citationid=\\\"CR16\\\" class=\\\"CitationRef\\\"\\u003e16\\u003c/span\\u003e]. Our findings support selective rather than universal prophylaxis, focusing on elderly patients with elevated D-dimer. The validation of our findings in larger multicenter cohorts is needed, and the optimization of outcomes in an aging breast cancer population could be enhanced by the integration of this risk stratification into perioperative care pathways.\\u003c/p\\u003e \\u003cp\\u003eThis study also underscores the importance of multidisciplinary team (MDT) care. Collaborations among breast surgeons, anesthesiologists, radiologists, and cardiologists ensured that the patients with preoperative VTE who treated at our hospital were appropriately anticoagulated and safely managed throughout the perioperative period. MDT approaches have been confirmed to improve cancer-associated VTE outcomes [\\u003cspan citationid=\\\"CR18\\\" class=\\\"CitationRef\\\"\\u003e18\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eInvestigations of D-dimer beyond its use for the prediction of VTE have been informative. For example, studies specific to breast cancer suggested that D-dimer may function as a prognostic marker and monitoring tool in patients undergoing systemic therapy [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e]. In the present study, the short observation period made prognostic analyses difficult, necessitating further investigations. Our findings support the role of D-dimer not only in ruling out VTE but also as a biologically meaningful marker in breast cancer. Not all cases with relatively elevated D-dimer levels have a confirmed VTE, and the significance of elevated D-dimer levels requires further investigation.\\u003c/p\\u003e \\u003cp\\u003eThis study has several limitations. It was a single-center retrospective study with a relatively small number of VTE events, limiting the generalizability of the results. In addition, D-dimer was not measured in all patients, which may have introduced selection bias. However, this investigation of a population with a high proportion of elderly patients is highly valuable. Finally, although the findings are hypothesis-generating, prospective multicenter studies are required to validate the predictive roles of age and D-dimer in this setting.\\u003c/p\\u003e \\u003cp\\u003eIn conclusion, preoperative VTE was not uncommon (7.0%) in this series of breast cancer patients, particularly in the elderly individuals. Elevated D-dimer and older age were independent predictors of VTE, and its combination allowed a simple risk stratification. Targeted screening and multidisciplinary perioperative management may enhance the safety of breast cancer surgery.\\u003c/p\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cdiv class=\\\"DefinitionList\\\"\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eBC\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e\\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ebreast cancer\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eVTE\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eVenous thromboembolism\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eDVT\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003edeep vein thrombosis\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ePE\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003epulmonary embolism\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eBMI\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003ebody mass index\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eNAC\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eneoadjuvant chemotherapy\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eCT\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eContrast-enhanced computed tomography\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eDOAC\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003edirect-acting oral anticoagulant\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003eER\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eestrogen receptor\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e \\u003cp\\u003ePgR\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/div\\u003e \\u003cdiv class=\\\"DefinitionListEntry\\\"\\u003e \\u003cdiv class=\\\"Term\\\"\\u003eprogesterone receptor.\\u003c/div\\u003e \\u003cdiv class=\\\"Description\\\"\\u003e\\u003c/div\\u003e \\u003c/div\\u003e \\u003c/div\\u003e\"},{\"header\":\"Declarations\",\"content\":\"\\u003cp\\u003e \\u003ch2\\u003eEthics approval and consent to participate\\u003c/h2\\u003e \\u003cp\\u003e This retrospective observational study was conducted in accordance with the ethical standards of the Clinical Ethics Committee of Nippon Medical School (approval No. M-2025-396) and the Declaration of Helsinki and its later amendments. The study used existing clinical information obtained during routine care. The Clinical Ethics Committee waived the requirement for written informed consent, and patients were provided with an opportunity to refuse participation via an opt-out procedure in accordance with the Japanese ethical guidelines via our institutional website and notice board. Data were de-identified prior to analysis.\\u003c/p\\u003e \\u003c/p\\u003e \\u003cp\\u003e \\u003cstrong\\u003eConsent for publication\\u003c/strong\\u003e \\u003cp\\u003eNot applicable\\u003c/p\\u003e \\u003c/p\\u003e\\u003cp\\u003e \\u003ch2\\u003eCompeting Interests\\u003c/h2\\u003e \\u003cp\\u003eThe authors have no conflicts of interest to declare.\\u003c/p\\u003e \\u003c/p\\u003e\\u003ch2\\u003eFunding\\u003c/h2\\u003e \\u003cp\\u003eNot applicable/ No funding was received.\\u003c/p\\u003e\\u003ch2\\u003eAuthor Contribution\\u003c/h2\\u003e\\u003cp\\u003eTF analyzed the data and wrote the initial draft of the manuscript. ES, SA, and RM collected the data and were involved in the initial study conception and design. TF, ES, SA, RM, and HT were involved in drafting and revising the manuscript. All authors have read and approved the final manuscript.\\u003c/p\\u003e\\u003ch2\\u003eAcknowledgements\\u003c/h2\\u003e \\u003cp\\u003eWe thank the radiologists and cardiologists at Nippon Medical School Chiba Hokusoh Hospital for their cooperation.\\u003c/p\\u003e\\u003ch2\\u003eData Availability\\u003c/h2\\u003e\\u003cp\\u003eThe datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eSung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F. Global Cancer Statistics 2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. 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Breast J. 2025;2025:9898596. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1155/tbj/9898596\\u003c/span\\u003e\\u003cspan address=\\\"10.1155/tbj/9898596\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePietrasik A, Gąsecka A, Kurzyna P, Smyk JM, Wasilewski M, Wolański R, Wrona K, Darocha S, Zieliński D, Grabowski M, Torbicki A, Kurzyna M. Cancer-associated thrombosis: comparison of characteristics, treatment, and outcomes in oncologic and nononcologic patients followed by a pulmonary embolism response team. Pol Arch Intern Med. 2023;133(7\\u0026ndash;8):16421. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.20452/pamw.16421\\u003c/span\\u003e\\u003cspan address=\\\"10.20452/pamw.16421\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e.\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCrichi B, Sebuhyan M, Abdallah NA, Montlahuc C, Bonnet C, Villiers S, Maignan CL, Yannoutsos A, Farge D. How to treat venous thromboembolism (TVE) in cancer patients: ten years of multidisciplinary team meetings (MDTM) at Saint-Louis Hospital. J Med Vasc. 2020;45(6S): 6S24-6S30. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/S2542-4513(20)30516-2\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/S2542-4513(20)30516-2\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":false,\"hideJournal\":false,\"highlight\":\"\",\"institution\":\"\",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcan\",\"sideBox\":\"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcan/default.aspx\",\"title\":\"BMC Cancer\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true},\"keywords\":\"breast cancer; venous thromboembolism, VTE, D-dimer, elderly patients, preoperative risk stratification\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-8409774/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-8409774/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003ch2\\u003eBackground\\u003c/h2\\u003e \\u003cp\\u003eAlthough venous thromboembolism (VTE) is a serious perioperative complication in cancer patients, its preoperative prevalence and predictors in breast cancer (BC) remain insufficiently defined. With the increasing incidence of BC worldwide and the aging population in Japan, elderly patients with BC represent a growing subgroup at risk of VTE.\\u003c/p\\u003e\\u003ch2\\u003ePatients and Methods:\\u003c/h2\\u003e \\u003cp\\u003eWe retrospectively analyzed the cases of 313 consecutive patients with BC who underwent breast surgery and preoperative evaluation at our institution. Clinical characteristics including age, comorbidities, and D-dimer level were collected. All of the patentis underwent imaging for the identification of VTE. We performed univariable and multivariable logistic regression analyses to identify predictors of VTE.\\u003c/p\\u003e\\u003ch2\\u003eResults\\u003c/h2\\u003e \\u003cp\\u003ePreoperative VTE was detected in 22 patients (7.0%). All cases were asymptomatic, and included pulmonary embolism (n\\u0026thinsp;=\\u0026thinsp;1, 0.3%), proximal deep vein thrombosis (n\\u0026thinsp;=\\u0026thinsp;2, 0.6%), and distal thrombosis (n\\u0026thinsp;=\\u0026thinsp;20, 6.4%). In the univariable analysis, age\\u0026thinsp;\\u0026ge;\\u0026thinsp;70 years (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) and D-dimer\\u0026thinsp;\\u0026ge;\\u0026thinsp;1 \\u0026micro;g/mL (p\\u0026thinsp;\\u0026lt;\\u0026thinsp;0.001) were significantly associated with VTE, and hypertension showed a marginal association. Age\\u0026thinsp;\\u0026ge;\\u0026thinsp;70 years and D-dimer\\u0026thinsp;\\u0026ge;\\u0026thinsp;1 \\u0026micro;g/mL remained an independent predictor. Predicted probabilities were negligible in the patients\\u0026thinsp;\\u0026lt;\\u0026thinsp;70 years, ~\\u0026thinsp;8% in those\\u0026thinsp;\\u0026ge;\\u0026thinsp;70 years with normal D-dimer, and ~\\u0026thinsp;26% in those\\u0026thinsp;\\u0026ge;\\u0026thinsp;70 years with elevated D-dimer. No patient experienced postoperative progression of VTE or a new pulmonary embolism.\\u003c/p\\u003e\\u003ch2\\u003eConclusions\\u003c/h2\\u003e \\u003cp\\u003ePreoperative VTE was not uncommon in this BC series, particularly among the elderly patients with older age and elevated D-dimer. The combination of age and D-dimer provided a simple and practical method for perioperative risk stratification. Targeted screening and management of high-risk patients may enhance surgical safety. Larger multicenter studies are warranted to validate this strategy.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Preoperative prevalence and risk factors of venous thromboembolism in patients with breast cancer: A retrospective cohort analysis\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2026-02-23 08:03:40\",\"doi\":\"10.21203/rs.3.rs-8409774/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0},{\"type\":\"decision\",\"content\":\"Revision requested\",\"date\":\"2026-04-02T18:45:22+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-21T11:05:25+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-21T01:24:21+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-11T18:17:08+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-03-08T20:57:16+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"editorInvitedReview\",\"content\":\"\",\"date\":\"2026-02-26T07:24:55+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"202249181399565988660498657069360712348\",\"date\":\"2026-02-25T02:31:41+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"17924781948434853800995693758645039739\",\"date\":\"2026-02-21T23:32:59+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"42976098948256330964437704628009139279\",\"date\":\"2026-02-21T20:23:20+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"217721614876964377510366149444027480232\",\"date\":\"2026-02-20T00:28:29+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"52308645092027691103578436126641070002\",\"date\":\"2026-02-19T10:59:07+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewerAgreed\",\"content\":\"206995450085292144529893157299863731353\",\"date\":\"2026-02-19T10:38:29+00:00\",\"index\":\"hide\",\"fulltext\":\"\"},{\"type\":\"reviewersInvited\",\"content\":\"\",\"date\":\"2026-02-19T05:15:21+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorAssigned\",\"content\":\"\",\"date\":\"2026-01-01T17:26:05+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"editorInvited\",\"content\":\"\",\"date\":\"2025-12-24T07:21:46+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"checksComplete\",\"content\":\"\",\"date\":\"2025-12-24T07:04:53+00:00\",\"index\":\"\",\"fulltext\":\"\"},{\"type\":\"submitted\",\"content\":\"BMC Cancer\",\"date\":\"2025-12-24T06:51:37+00:00\",\"index\":\"\",\"fulltext\":\"\"}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"bmc-cancer\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":false,\"externalIdentity\":\"bcan\",\"sideBox\":\"Learn more about [BMC Cancer](http://bmccancer.biomedcentral.com/)\",\"snPcode\":\"\",\"submissionUrl\":\"https://www.editorialmanager.com/bcan/default.aspx\",\"title\":\"BMC Cancer\",\"twitterHandle\":\"BMC_series\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"em\",\"reportingPortfolio\":\"BMC Series\",\"inReviewEnabled\":true,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"0f244899-606a-43dd-bc98-558e21dd29f5\",\"owner\":[],\"postedDate\":\"February 23rd, 2026\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"under-review\",\"subjectAreas\":[],\"tags\":[],\"updatedAt\":\"2026-05-16T08:23:13+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2026-02-23 08:03:40\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-8409774\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-8409774\",\"identity\":\"rs-8409774\",\"version\":[\"v1\"]},\"buildId\":\"XKTyCvWXoU3ODBz1xrDgd\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}