Prediction of Deep Vein Thrombosis after Total Knee Arthroplasty with Preoperative D-Dimer Plasma Measurement
Thanainit Chotanaphuthi MD*, Danai Heebthamai MD*, Worasun Taweewuthisub MD**, Satit Thiengwittayaporn MD**, Suwat Roschan MD*, Kris Kanchanaroek MD*
Affiliation : * Department of Orthopaedics, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand ** Department of Orthopaedics Surgery, Bangkok Metropolitan Administration Medical College and Vajira Hospital, Bangkok,Thailand
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 of DVT 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.
Material and Method: 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-10th 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.
Conclusion : 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.
Keywords : Deep vein thrombosis, Total knee arthroplasty, D-dimer
