Abstract
Background and purposeThe 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.MethodsThe 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.ResultsVenographic DVT was identified in 40% of patients. High plasma D-dimer level >2.0 μg/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 μg/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.ConclusionHigh 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.
Highlights
Background and purposeThe relationship of D-dimer and deep-vein thrombosis (DVT) after total knee arthroplasty (TKA) remains controversial
Recent studies have shown that the incidence of deep-vein thrombosis (DVT) after total knee arthroplasty (TKA) in Asian patients is as high as that of the Western countries [1,2,3,4,5,6,7,8,9]
Deep-vein thrombosis after TKA is sometimes difficult to diagnose because more than half of DVT cases after TKA are asymptomatic [3], which might cause propagation of the clots leading to pulmonary embolism [7]
Summary
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. Recent studies have shown that the incidence of deep-vein thrombosis (DVT) after total knee arthroplasty (TKA) in Asian patients is as high as that of the Western countries [1,2,3,4,5,6,7,8,9]. Pharmaceutical prophylaxis significantly lowered the incidence of DVT, but none of currently available modalities showed total prevention of DVT [3]. Patients often refuse venography and orthopedic surgeons are reluctant to recommend the procedure.
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