title: Associations between venous thromboembolism onset, D-dimer, and soluble fibrin monomer complex after total knee arthroplasty.
abstract: BACKGROUND
  Prevention and early detection of venous thromboembolism (VTE) is important after arthroplasty of the lower limb. The purpose of this study was to investigate the associations between VTE and hemostatic markers after minimally invasive total knee arthroplasty (MIS-TKA).
  
  
  METHODS
  We performed a retrospective study of 50 patients (55 knees) who underwent primary unilateral MIS-TKA with periodic determination of D-dimer and soluble fibrin monomer complex (SFMC) concentrations and with ultrasonography. The development of symptomatic and asymptomatic VTE, location of deep venous thrombosis (DVT; proximal or distal), changes in SFMC and D-dimer concentrations, and correlations between hemostatic markers and VTE onset were evaluated.
  
  
  RESULTS
  Twenty-six patients (47%) had an asymptomatic distal DVT, but none had proximal DVT, pulmonary embolism, or symptomatic DVT. DVT was detected at postoperative day 1 (POD1) in 16 patients, POD3 in six, and POD5 in three (excluding detections of the same DVT in the same position on different days). DVT onset correlated significantly with SFMC concentration on POD1 and with D-dimer concentration on POD3. The D-dimer concentration did not differ significantly between patients who developed DVT (DVT+) and those who did not (DVT-) at each postoperative time. SFMC concentration differed between DVT+ and DVT- patients only on POD1. Analysis of each hemostatic marker classified as either within or outside the normal concentration range showed no significant correlations between D-dimer concentration and DVT onset at each period. There were significant correlations between SFMC concentrations and DVT onset on POD1 and POD3. There were also significant correlations between D-dimer positive (+) findings and/or SFMC+ findings and DVT onset on POD1 and POD3. D-dimer+ and/or SFMC+ findings had better specificity on POD1 and a positive predictive value on POD1 and POD3 compared with SFMC+ alone.
  
  
  CONCLUSIONS
  SFMC concentration is an effective hemostatic marker for early detection of DVT. D-dimer concentration alone has limited value as a hemostatic marker for early detection of DVT. Measurement of both D-dimer and SFMC concentrations might be a more sensitive diagnostic tool than measuring SFMC concentration alone.
authors.affiliation: Department of Orthopaedic Surgery, Tokai University Oiso Hospital, Gakkyou 21-1, Oiso, Naka-gun, Kanagawa, 259-0198, Japan. genya@syd.odn.ne.jp.
authors.forename: Genya
authors.initials: G
authors.lastname: Mitani
authors.affiliation: Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan. t-tom8@pc4.so-net.ne.jp.
authors.forename: Tomonori
authors.initials: T
authors.lastname: Takagaki
authors.affiliation: Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan. hamako@is.icc.u-tokai.ac.jp.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Hamahashi
authors.affiliation: Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan. serigano@is.icc.u-tokai.ac.jp.
authors.forename: Kenji
authors.initials: K
authors.lastname: Serigano
authors.affiliation: Department of Physical Recreation, School of Physical Education, Tokai University, 4-1-1 Kitakaname, Hiratsuka, Kanagawa, 259-1292, Japan. yutaka@keyaki.cc.u-tokai.ac.jp.
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan. sato-m@is.icc.u-tokai.ac.jp.
authors.forename: Masato
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Orthopaedic Surgery, Surgical Science, Tokai University School of Medicine, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan. jomo@is.icc.u-tokai.ac.jp.
authors.forename: Joji
authors.initials: J
authors.lastname: Mochida
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D015415:Biomarkers / Q000097:blood; D005260:Female; D005337:Fibrin / Q000378:metabolism*; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006487:Hemostasis; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D019990:Perioperative Care / Q000379:methods; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D054556:Venous Thromboembolism / Q000097:blood / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control
chemical_list: D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; C465961:thrombus precursor protein, human; D005337:Fibrin