Association between perioperative D-dimer dynamics and post-treatment localized intravascular coagulation in venous malformations.

OBJECTIVE

To investigate the association between the change in D-dimer levels (ΔD-dimer) and the development of localized intravascular coagulation (LIC) following surgical intervention in patients with venous malformations.

METHODS

This retrospective cohort study enrolled 267 patients with venous malformations who underwent surgical treatment at Fujian Maternity and Child Health Hospital between June 2021 and December 2025. The primary exposure variable was the preoperative-to-postoperative ΔD-dimer. The principal outcome was postoperative LIC. Multivariable logistic regression analysis was employed to estimate the effect size, adjusted for potential confounders.

RESULTS

The incidence of LIC was 31.1% (83/267). Each unit increase in ΔD-dimer was significantly associated with a higher risk of LIC (adjusted odds ratio [aOR] = 2.51; 95% confidence interval [CI]: 1.93-3.26; p < 0.001). This association was consistent across stratified subgroups, including sex, age, number of lesions, tissue layer involvement, lesion volume, lesion location, surgical approach, and anticoagulation status (all P for interaction > 0.05), with a borderline interaction by head/neck involvement (P for interaction = 0.054). ΔD-dimer is independently associated with postoperative LIC in patients with venous malformations, with a monotonic dose-response relationship. A threshold near 4.8 mg/L FEU is suggested by exploratory segmented analysis but requires external validation before any clinical use.

CONCLUSION

ΔD-dimer is independently associated with postoperative LIC in patients with venous malformations, demonstrating a significant dose-response relationship. Collectively, these findings suggest that ΔD-dimer is independently associated with postoperative LIC and may serve as a risk marker for perioperative coagulation monitoring.