Association Between Pre-operative D-dimer and Deep Vein Thrombosis Risk in Patients with Spine Tumors

Introduction: Deep vein thrombosis (DVT) is a common and dangerous complication of spine surgery. Understanding DVT risk is key in guiding preventative measures perioperatively. Cancer patients are at increased risk for DVT, however few studies have investigated risk factors for DVT in patients with spine tumors. This study aimed to assess the incidence of DVT in the spine tumor population and determine whether pre-operative D-dimer is associated with DVT risk.

Methods: Adult patients with spine tumors who had surgery at an academic institution between January 2021 and September 2024 were reviewed retrospectively. Incidence of perioperative DVT was recorded. D-dimer was compared between patients who developed DVT and those who did not. Age sex, tumor type, and spinal level of tumor were also investigated as potential risk factors. Differences between groups were assessed using the chi-square test for categorical variables and the t-test or Mann Whitney for continuous variables. Results are reported as means with SD.

Results: Of the 143 patients included in this study, 70.6% had spine metastases, 16.1% had intradural tumors, and 15.4% had primary bone tumors. DVT occurred in 5.9% of patients. Average D-dimer in patients who developed DVT (2100 +/- 2605 ng/mL) was higher than that of patients who did not develop DVT (1530 +/- 1943 ng/mL), however this difference was non-significant. Age, sex, tumor type, and spinal level of tumor were also not significant predictors of DVT risk.

Conclusion : Pre-operative D-dimer was not predictive of DVT risk in spine tumor patients undergoing surgery. Most patients had elevated D-dimer levels whether or not they developed a DVT, which may reflect the hypercoagulable state induced by cancer at baseline. Therefore, our results suggests that D-dimer may not be a clinically useful indicator of DVT risk in the spine tumor population.