Temporal Patterns and Clinical Significance of D-dimer Change Following Metabolic and Bariatric Surgery: A Systematic Review

Background Venous thromboembolism (VTE) remains a leading cause of mortality following metabolic and bariatric surgery. Although D-dimer is a widely used biomarker of fibrinolysis and thrombosis, postoperative D-dimer kinetics after MBS have not been systematically characterized. Objectives To describe the temporal pattern of perioperative D-dimer changes after MBS and assess the relationship with procedural invasiveness and detected VTE events. Methods We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. MEDLINE, Embase, Web of Science, Scopus, and Cochrane Central were searched from inception to 30 October 2025. We included cohort studies and randomized controlled trials reporting D-dimer levels in adults undergoing MBS. Two reviewers independently screened studies, extracted data, and assessed quality using the Cochrane Risk of Bias 2.0 tool and the Newcastle-Ottawa Scale. Results Eight studies (522 patients) were included. The majority of studies demonstrated postoperative D-dimer elevation (86.6% to 496% above baseline), with four distinct temporal patterns: early peak within 24 hours (2 studies, up to 496% increase), delayed peak at days 1–2 with subsequent decline (2 studies), sustained elevation at 1 month (2 studies), and long-term decline below baseline at follow-up (2 studies). Despite marked elevations, VTE incidence was low (0.38%, 2/522 patients). One study documented persistent thromboelastography hypercoagulability at 6 months despite D-dimer normalization. Conclusions D-dimer elevations are common after metabolic and bariatric surgery, but may has limited clinical utility for VTE. Conventional markers may underestimate prolonged hypercoagulability. Clinical evaluation should guide thromboprophylaxis rather than routine D-dimer monitoring.