The Value of D-dimer in the Detection of Early Deep-vein Thrombosis After Total Knee Arthroplasty in Asian Patients: a Cohort Study

Overview

Journal Thromb J

Publisher Biomed Central

Date 2008 May 29

PMID 18505594

Citations 20

Authors

Chung-Jen Chen

Ching-Jen Wang

Chung-Cheng Huang

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: The relationship of D-dimer and deep-vein thrombosis (DVT) after total knee arthroplasty (TKA) remains controversial. The purpose of this study was to assess the value of D-dimer in the detection of early DVT after TKA.

Methods: The measurements of plasma D-dimer level were obtained preoperatively and at day 7 postoperatively in 78 patients undergoing TKA. Ascending venography was performed in 7 to 10 days after surgery. The plasma D-dimer levels were correlated statistically with the venographic DVT.

Results: Venographic DVT was identified in 40% of patients. High plasma D-dimer level >2.0 mug/ml was found in 68% of patients with DVT and 45% without DVT (P < 0.05). Therefore, high D-dimer level greater than 2.0 mug/ml showed 68% sensitivity, 55% specificity, 60% accuracy, 50% positive predictive rate and 72% negative predictive rate in the detection of early DVT after TKA.

Conclusion: High plasma D-dimer level is a moderately sensitive, but less specific marker in the detection of early of DVT after TKA. Measurement of serum D-dimer alone is not accurate enough to detect DVT after TKA. Venography is recommended in patients with elevated D-dimer and clinically suspected but asymptomatic DVT after TKA.

Citing Articles

The effect of triple-dose-intravenous tranexamic acid on blood loss in patients undergoing total hip arthroplasty without affecting blood coagulopathy: A prospective thromboelastographic analysis.

Jin W, Yan Z, Zhang X, Pan S, Huang C, Guo K Acta Orthop Traumatol Turc. 2023; .

PMID: 37987599 PMC: 10837608. DOI: 10.5152/j.aott.2023.23001.

Efficacy of Coagulofibrinolytic Markers for Postoperative Prediction of Venous Thromboembolism in Colorectal Surgery Patients: A Retrospective Observational Study.

Matsumoto H, Ishimaru K, Kikuchi S, Akita S, Yamamoto Y, Yoshida M J Anus Rectum Colon. 2023; 7(3):140-149.

PMID: 37496570 PMC: 10368431. DOI: 10.23922/jarc.2022-077.

Utility of D-dimer in total joint arthroplasty.

Cutter B, Lum Z, Giordani M, Meehan J World J Orthop. 2023; 14(3):90-102.

PMID: 36998388 PMC: 10044320. DOI: 10.5312/wjo.v14.i3.90.

What is the best prophylaxis against venous thromboembolism in Asians following total knee arthroplasty? A systematic review and network meta-analysis.

Wong S, Ler F, Sultana R, Bin Abd Razak H Knee Surg Relat Res. 2022; 34(1):37.

PMID: 35964142 PMC: 9375282. DOI: 10.1186/s43019-022-00166-y.

The role of serum D-Dimer for the diagnosis of periprosthetic shoulder infection.

Akgun D, Al-Muhtaresh F, Paksoy A, Lacheta L, Minkus M, Karczewski D Arch Orthop Trauma Surg. 2022; 143(4):1855-1860.

PMID: 35182199 PMC: 10030413. DOI: 10.1007/s00402-022-04385-6.

References

Wang C, Wang J, Weng L, Hsu C, Huang C, Yu P . Prevention of deep-vein thrombosis after total knee arthroplasty in Asian patients. Comparison of low-molecular-weight heparin and indomethacin. J Bone Joint Surg Am. 2004; 86(1):136-40. DOI: 10.2106/00004623-200401000-00020. View

Wells P, Anderson D, Rodger M, Forgie M, Kearon C, Dreyer J . Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003; 349(13):1227-35. DOI: 10.1056/NEJMoa023153. View

Kim Y, Kim J . Incidence and natural history of deep-vein thrombosis after total knee arthroplasty. A prospective, randomised study. J Bone Joint Surg Br. 2002; 84(4):566-70. DOI: 10.1302/0301-620x.84b4.12330. View

Maynard M, Sculco T, Ghelman B . Progression and regression of deep vein thrombosis after total knee arthroplasty. Clin Orthop Relat Res. 1991; (273):125-30. View

Watanabe R, Wada H, Mori Y, Nakasaki T, Sawa H, Shiku H . [Plasma D-dimer levels in patients with deep vein thrombosis]. Rinsho Byori. 1999; 47(9):887-90. View

Legnani C, Pancani C, Palareti G, Guazzaloca G, Fortunato G, Grauso F . Comparison of new rapid methods for D-dimer measurement to exclude deep vein thrombosis in symptomatic outpatients. Blood Coagul Fibrinolysis. 1997; 8(5):296-302. DOI: 10.1097/00001721-199707000-00006. View

Mazzolai L, Haesler E, Milesi I, Hayoz D . D-dimers testing is not recommended for the exclusion of deep vein thrombosis in outpatients with lower limb erysipelas. Thromb Haemost. 2002; 88(5):880. View

Arnesen H, Dahl O, Aspelin T, Seljeflot I, Kierulf P, Lyberg T . Sustained prothrombotic profile after hip replacement surgery: the influence of prolonged prophylaxis with dalteparin. J Thromb Haemost. 2003; 1(5):971-5. DOI: 10.1046/j.1538-7836.2003.00111.x. View

Schellong S, Beyer J, Kakkar A, Halbritter K, Eriksson B, Turpie A . Ultrasound screening for asymptomatic deep vein thrombosis after major orthopaedic surgery: the VENUS study. J Thromb Haemost. 2007; 5(7):1431-7. DOI: 10.1111/j.1538-7836.2007.02570.x. View

10.

Shiota N, Sato T, Nishida K, Matsuo M, Takahara Y, Mitani S . Changes in LPIA D-dimer levels after total hip or knee arthroplasty relevant to deep-vein thrombosis diagnosed by bilateral ascending venography. J Orthop Sci. 2002; 7(4):444-50. DOI: 10.1007/s007760200077. View

11.

Larsen T, Stoffersen E, Christensen C, Laursen B . Validity of D-dimer tests in the diagnosis of deep vein thrombosis: a prospective comparative study of three quantitative assays. J Intern Med. 2002; 252(1):36-40. DOI: 10.1046/j.1365-2796.2002.00998.x. View

12.

Lennox A, Delis K, Serunkuma S, Zarka Z, Daskalopoulou S, Nicolaides A . Combination of a clinical risk assessment score and rapid whole blood D-dimer testing in the diagnosis of deep vein thrombosis in symptomatic patients. J Vasc Surg. 1999; 30(5):794-803. DOI: 10.1016/s0741-5214(99)70003-0. View

13.

Crippa L, DAngelo S, Tomassini L, Rizzi B, DAlessandro G, DAngelo A . The utility and cost-effectiveness of D-dimer measurements in the diagnosis of deep vein thrombosis. Haematologica. 1997; 82(4):446-51. View

14.

Bounameaux H, Miron M, Blanchard J, de Moerloose P, Hoffmeyer P, Leyvraz P . Measurement of plasma D-dimer is not useful in the prediction or diagnosis of postoperative deep vein thrombosis in patients undergoing total knee arthroplasty. Blood Coagul Fibrinolysis. 1999; 9(8):749-52. DOI: 10.1097/00001721-199811000-00004. View

15.

Lensing A, Prandoni P, Brandjes D, Huisman P, Vigo M, Tomasella G . Detection of deep-vein thrombosis by real-time B-mode ultrasonography. N Engl J Med. 1989; 320(6):342-5. DOI: 10.1056/NEJM198902093200602. View

16.

Legnani C, Pancani C, Palareti G, Guazzaloca G, Coccheri S . Contribution of a new, rapid, quantitative and automated method for D-dimer measurement to exclude deep vein thrombosis in symptomatic outpatients. Blood Coagul Fibrinolysis. 1999; 10(2):69-74. DOI: 10.1097/00001721-199903000-00002. View

17.

Harvey R, Roth E, Yarnold P, DURHAM J, Green D . Deep vein thrombosis in stroke. The use of plasma D-dimer level as a screening test in the rehabilitation setting. Stroke. 1996; 27(9):1516-20. DOI: 10.1161/01.str.27.9.1516. View

18.

Miric A, Lombardi P, Sculco T . Deep vein thrombosis prophylaxis: a comprehensive approach for total hip and total knee arthroplasty patient populations. Am J Orthop (Belle Mead NJ). 2000; 29(4):269-74. View

19.

Leizorovicz A, Turpie A, Cohen A, Wong L, Yoo M, Dans A . Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART study. J Thromb Haemost. 2005; 3(1):28-34. DOI: 10.1111/j.1538-7836.2004.01094.x. View

20.

Declerck P, Mombaerts P, Holvoet P, de Mol M, Collen D . Fibrinolytic response and fibrin fragment D-dimer levels in patients with deep vein thrombosis. Thromb Haemost. 1987; 58(4):1024-9. View