title: Pilot study on the use of tourniquet: a risk factor for pulmonary thromboembolism after total knee arthroplasty?
abstract: The risk of pulmonary thromboembolism (PTE) after total knee arthroplasty (TKA) with tourniquet is still controversial. In this study, we determined whether plasma D-dimer could be used as a marker of PTE, and whether intraoperative use of tourniquet is a risk factor for symptomatic PTE after TKA. We divided 86 patients (12 males and 74 females) who underwent primary TKA into four groups based on (i) operation method (unilateral/bilateral) and (ii) use of pneumatic tourniquet during surgery (with/without). Plasma D-dimer values were measured preoperatively and on Day 1 postoperatively. "D1-value" was defined as the difference between postoperative and preoperative plasma D-dimer levels. We determined the cutoff level of "D1-value" for symptomatic PTE, monitored by O(2) saturation (SAT) and lung scintigraphy. "D1-values" for patients with PTE symptoms were higher than those without symptoms (p<0.001). Furthermore, "D1-values" for TKA without tourniquet procedures were significantly lower than those with tourniquet both in unilateral (p=0.003) and bilateral groups (p=0.004). At a cutoff level of >or=8.6 mug/mL, the sensitivity, specificity, and positive and negative predictive values were 100%, 82.5%, 30.0% and 100% for symptomatic PTE, respectively. The results of our pilot study showed that elevated plasma "D1 value" is a sensitive marker for detection of PTE. Further studies will be needed, in order to evaluate the risk of tourniquet, and to reduce PTE after TKA.
authors.affiliation: Department of Orthopaedic Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Nishiguchi
authors.forename: Noboru
authors.initials: N
authors.lastname: Takamura
authors.forename: Yasuyo
authors.initials: Y
authors.lastname: Abe
authors.forename: Masafumi
authors.initials: M
authors.lastname: Kono
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Shindo
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Aoyagi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D015415:Biomarkers / Q000097:blood; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011655:Pulmonary Embolism / Q000097:blood / Q000209:etiology*; D012307:Risk Factors; D014111:Tourniquets / Q000009:adverse effects*
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D