Prediction of deep vein thrombosis after total knee arthroplasty with preoperative D-dimer plasma measurement.
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.
Chotanaphuthi
Thanainit
T
Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand. tanainit@hotmail.com
Heebthamai
Danai
D
Taweewuthisub
Worasun
W
Thiengwittayaporn
Satit
S
Roschan
Suwat
S
Kanchanaroek
Kris
K
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
D000933:Antifibrinolytic Agents; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D