Department of Orthopedic Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Thromb J. 2008 May 28;6:5. doi: 10.1186/1477-9560-6-5.
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.
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.
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.
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.
全膝关节置换术后（TKA）患者 D-二聚体与深静脉血栓（DVT）的关系仍存在争议。本研究旨在评估 D-二聚体在 TKA 后早期 DVT 检测中的价值。
对 78 例行 TKA 的患者术前和术后第 7 天进行血浆 D-二聚体水平测量。术后 7 至 10 天行上行静脉造影。对血浆 D-二聚体水平与静脉造影 DVT 进行统计学相关性分析。
40%的患者存在静脉造影 DVT。DVT 患者的血浆 D-二聚体水平较高（>2.0ug/ml），占 68%，无 DVT 患者占 45%（P<0.05）。因此，D-二聚体水平大于 2.0ug/ml 时，对 TKA 后早期 DVT 的检测具有 68%的敏感性、55%的特异性、60%的准确性、50%的阳性预测率和 72%的阴性预测率。
高血浆 D-二聚体水平是 TKA 后早期 DVT 检测的一种中等敏感但特异性较低的标志物。单独测量血清 D-二聚体不足以检测 TKA 后 DVT。建议对 D-二聚体升高且临床怀疑但无症状的 TKA 后 DVT 患者进行静脉造影。
