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Disease-specific screening for deep venous thrombosis and pulmonary thromboembolism using plasma d-dimer values after total knee arthroplasty

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Modern Rheumatology

Abstract

We prospectively evaluated the disease-specific features of the early postoperative plasma d-dimer value and the relationship with deep venous thrombosis and/or pulmonary thromboembolism (DVT/PE) in 95 patients following total knee arthroplasty. Patients in whom DVT/PE was highly suspected were diagnosed by high-resolution multi-detector row computed tomography scanning (MDCT). Forty-nine knees in 46 patients with rheumatoid arthritis (RA, 24 knees) or osteoarthritis (OA, 25 knees) were finally recruited. DVT/PE was detected in 28 (57.1%) of the 49 cases examined by diagnostic MDCT: 12 (50.0%) of the 24 cases of RA, and 16 (64.0%) of the 25 cases of OA. Of these, PE was found in 11 cases (39.2%), but none of them showed clinical symptomatic signs of dyspnea or chest pain. In both RA and OA cases, there were statistically significant differences in the d-dimer value on postoperative day 3 (P = 0.027) and after day 28 (P = 0.037) between the groups with and without DVT/PE. In OA cases, there were significant differences between the two groups on postoperative days 1 (P = 0.034), 3 (P = 0.020), 5 (P = 0.005), and 7 (P = 0.045), respectively. At the baseline, perioperative d-dimer levels in the RA group without DVT/PE were higher than in the OA group. However, multivariate logistic regression analysis showed that RA was not a significant risk factor of DVT/PE in comparison with OA. In conclusion, individual evaluation of the d-dimer level between RA and OA should provide a more precise predictive indicator of early postoperative DVT/PE.

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Acknowledgments

We wish to thank Dr. Toru Miyoshi for critical reading of the manuscript, and in particular statistical analysis of the data. No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Okayama University Hospital, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan

    Teruhito Yoshitaka & Nobuhiro Abe

  2. Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan

    Hiroshi Minagawa, Hirokazu Date, Yoshimasa Sakoma & Toshifumi Ozaki

  3. Department of Human Morphology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan

    Keiichiro Nishida

Authors
  1. Teruhito Yoshitaka
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  2. Nobuhiro Abe
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  3. Hiroshi Minagawa
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  4. Hirokazu Date
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  5. Yoshimasa Sakoma
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  6. Keiichiro Nishida
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  7. Toshifumi Ozaki
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Correspondence to Nobuhiro Abe.

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Yoshitaka, T., Abe, N., Minagawa, H. et al. Disease-specific screening for deep venous thrombosis and pulmonary thromboembolism using plasma d-dimer values after total knee arthroplasty. Mod Rheumatol 18, 359–365 (2008). https://doi.org/10.1007/s10165-008-0068-6

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  • DOI: https://doi.org/10.1007/s10165-008-0068-6

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