title: Prediction of deep vein thrombosis after total knee arthroplasty with preoperative D-dimer plasma measurement.
abstract: BACKGROUND
  Despite prophylaxis, deep vein thrombosis (DVT) still occurs frequently after elective knee surgery. Hence, it would be helpful if the high-risk DVT patients could be identified before surgery so the adequate prophylaxis could be given. A normal plasma D-dimer level effectively rules out acute DVT patients who were classified as having low clinical probability. In many studies, one coagulation activation marker was measured to observe their role in preoperative prediction ofDVT after major hip or knee surgery. In this study, the preoperative plasma level of D-dimer in patients undergoing total knee arthroplasty (TKA) was collected, and correlated with the results of postoperative venography
  
  
  OBJECTIVE
  To determine whether levels of D-dimer in plasma, taken two weeks preoperatively, predicts the development of DVT in patients undergoing TKA.
  
  
  METHODS
  Fifty-nine consecutive patients undergoing TKA were seen in a preoperative clinic two weeks prior the surgery and had blood taken for measurement of plasma D-dimer. After surgery, they did not receive prophylaxis anticoagulant. Ascending contrast venography of both lower extremities was performed in all cases between the 6th-l0th postoperative day or earlier if clinical symptoms occurred.
  
  
  RESULTS
  Plasma D-dimer was measured preoperatively in 59 patients undergoing TKA. DVT was detected by venography in 31 (53%) patients. At a cutoff or 500 ng/ml, the sensitivity, specificity, positive and negative predictive values of the preoperative D-dimer concentration for the development of subsequent DVT were 58%, 46%, 55%, and 50%, respectively.
  
  
  CONCLUSIONS
  The results of the present study suggested that preoperative plasma measurement of D-dimer concentration is not useful for predicting DVT in patients undergoing TKA.
authors.affiliation: Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand. tanainit@hotmail.com
authors.forename: Thanainit
authors.initials: T
authors.lastname: Chotanaphuthi
authors.forename: Danai
authors.initials: D
authors.lastname: Heebthamai
authors.forename: Worasun
authors.initials: W
authors.lastname: Taweewuthisub
authors.forename: Satit
authors.initials: S
authors.lastname: Thiengwittayaporn
authors.forename: Suwat
authors.initials: S
authors.lastname: Roschan
authors.forename: Kris
authors.initials: K
authors.lastname: Kanchanaroek
mesh_terms: D000368:Aged; D000933:Antifibrinolytic Agents / Q000378:metabolism; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010690:Phlebography; D011183:Postoperative Complications / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology / Q000517:prevention & control; D011184:Postoperative Period; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012307:Risk Factors; D012680:Sensitivity and Specificity; D020246:Venous Thrombosis / Q000097:blood* / Q000000981:diagnostic imaging / Q000209:etiology
chemical_list: D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D