title: Predictive blood coagulation markers for early diagnosis of venous thromboembolism after total knee joint replacement.
abstract: Pulmonary embolism development may be prevented if asymptomatic venous thromboembolism (VTE) can be predicted and treated preoperatively or soon after total knee arthroplasty (TKA). The purpose of this study was to evaluate whether asymptomatic VTE can be predicted by blood coagulation markers preoperatively or early after TKA. This prospective single-centre study enrolled 68 patients (6 men, 62 women; mean age: 71 years) who underwent TKA between September 2004 and August 2009. Sixteen-row multidetector computed tomography was performed 4 days before and after surgery for diagnosis of asymptomatic VTE. Blood samples were taken to measure the plasma levels of soluble fibrin monomer complex (SFMC), D-dimer and cross-linked fibrin degradation products by leukocyte elastase (e-XDP) at 4 days preoperatively, and at 1 hour, 1 day and 4 days postoperatively. The preoperative SFMC, D-dimer and e-XDP levels did not differ significantly between the thrombus (n=36) and no-thrombus (n=32) groups. D-dimer and e-XDP levels showed the most significant increases at days 4 and 1, respectively, after surgery in the thrombus group. With cut-off points of 7.5 μg/ml for D-dimer and 8.2 U/ml for e-XDP, the sensitivities were 75% and 75%, and the specificities were 63% and 59%, respectively. By multiple logistic regression analysis, D-dimer at day 4 and e-XDP at day 1 postoperatively were independent markers for early diagnosis of VTE (odds ratio=1.61 and 1.19, P=0.01 and 0.04, respectively). The postoperative occurrence of new asymptomatic VTE may be predicted by D-dimer at day 4 and e-XDP at day 1 after TKA.
authors.affiliation: Department of Orthopaedic Surgery, Jichi Medical University, Tochigi, Japan. watahide1968@jichi.ac.jp
authors.forename: Hideaki
authors.initials: H
authors.lastname: Watanabe
authors.forename: Seiji
authors.initials: S
authors.lastname: Madoiwa
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Sekiya
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nagahama
authors.forename: Shirou
authors.initials: S
authors.lastname: Matsuura
authors.forename: Yusei
authors.initials: Y
authors.lastname: Kariya
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Ohmori
authors.forename: Jun
authors.initials: J
authors.lastname: Mimuro
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Hoshino
authors.forename: Shinya
authors.initials: S
authors.lastname: Hayasaka
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Sakata
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000601:surgery; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects* / Q000379:methods; D015415:Biomarkers / Q000032:analysis; D001777:Blood Coagulation / Q000502:physiology*; D042241:Early Diagnosis; D005260:Female; D005337:Fibrin / Q000032:analysis; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D006801:Humans; D019272:Leukocyte Elastase / Q000097:blood; D008297:Male; D061330:Multidetector Computed Tomography / Q000379:methods; D020370:Osteoarthritis, Knee / Q000601:surgery; D011446:Prospective Studies; D054556:Venous Thromboembolism / Q000097:blood* / Q000175:diagnosis / Q000209:etiology
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; C465961:thrombus precursor protein, human; D005337:Fibrin; D019272:Leukocyte Elastase