Is early bilateral compression ultrasonography and D-dimer monitoring appropriately for prophylaxis and diagnosis of deep venous thrombosis after Cesarean section women: a single-center observation study of Chinese Han population

Objective: Venous thromboembolism (VTE) is most common in parturient after cesarean section (CS), the purpose of this study was to explore the practical value of bilateral compression ultrasonography of the legs along with D-dimer monitoring in the prevention and early diagnosis of VTE in the Han Chinese population. Materials: and methods 742 women with ultrasound examination and D-dimer testing on the first day after CS were involved in our prospective observation study in southeast China. Except for normal and thrombosis, other ultrasonic findings were defined as abnormal. D-dimer ≥3 mg/l was used as the VTE alarm value in our study, and early ambulation and mechanical prophylaxis were recommended to all women. A sequential diagnostic strategy was based on the 2015 RCOG VTE risk-assessment tool, parturient with abnormal ultrasound and D-dimer ≥ 3 mg/l were given pharmacological VTE prophylaxis with LMWH and all high-risk women also treated with preventive LMWH. The statistical analysis was carried out using R statistical software. Two-sided P value < 0.05 was deemed statistically significant. Result: There are 15 VTE cases and 727 women without VTE were observed, the patient age and mean D-dimer level during the day after Cesarean section were significant difference between two groups. The overall rate of VTE after CS was 2.02%, and most of them (66.7%) were asymptomatic. 10 patients were diagnosed at the first postpartum day. None maternal deaths occurred in the study cohort. 41 parturient had abnormal ultrasound and D-dimer ≥ 3 mg/l, although they had pharmacological VTE prophylaxis with LMWH, 2 (3.85%) of them in high risk group were finally diagnosed VTE. 229 parturient (30.86%) had normal ultrasound and D-dimer < 3 mg/l on the first day after CS, and no VTE occurred in the postpartum follow-up. Only 20.62% parturient had met our criterion for prophylactic anticoagulation while 78.03% according to RCOG’s recommendation. Conclusion: The strategy of timely routine bilateral compression ultrasonography (CUS) of lower limbs and D-dimer monitoring is conductive to early diagnosis, early prevention and early treatment of VTE, and greatly reduced the use of LWMH.