Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Edobashi, Tsu City, Mie, 514-8507, Japan.
Thromb Res. 2012 Nov;130(5):759-64. doi: 10.1016/j.thromres.2011.11.046. Epub 2011 Dec 21.
There are many reports concerning the fondaparinux prophylaxis of deep vein thrombosis (DVT) after surgery, but little is known about the usefulness of diagnosing DVT by the thrombotic markers such as soluble fibrin (SF) and D-dimer in patients treated with fondaparinux. The main purpose of this study was to evaluate the accuracy of SF and D-dimer tests for DVT screening in patients undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA) treated with fondaparinux.
A total of 519 patients who underwent THA or TKA were evaluated. SF and D-dimer levels were evaluated on postoperative days 1, 4, 7, 14 and 21. DVT was confirmed by ultrasonography 4 days after surgery.
The incidence of DVT in patients treated with fondaparinux was significantly lower than in patients without fondaparinux. The SF test on postoperative day 1, and the D-dimer test on postoperative days 1, 4, and 7 were useful in untreated patients. However, in the patients treated with fondaparinux, the D-dimer test on postoperative day 7 only was useful for DVT screening.
The accuracy of SF and D-dimer test for the diagnosis of DVT was decreased by administration of fondaparinux. A new strategy for diagnosing DVT might be required for patients receiving fondaparinux.
有许多关于达肝素钠预防手术后深静脉血栓形成（DVT）的报道，但对于接受达肝素钠治疗的患者，血栓标志物如可溶性纤维蛋白（SF）和 D-二聚体用于诊断 DVT 的有用性知之甚少。本研究的主要目的是评估 SF 和 D-二聚体检测在接受全髋关节置换术（THA）和全膝关节置换术（TKA）的接受达肝素钠治疗的患者中用于 DVT 筛查的准确性。
共评估了 519 例接受 THA 或 TKA 的患者。在术后第 1、4、7、14 和 21 天评估 SF 和 D-二聚体水平。术后第 4 天通过超声检查确认 DVT。
接受达肝素钠治疗的患者 DVT 发生率明显低于未接受达肝素钠治疗的患者。未接受达肝素钠治疗的患者，术后第 1 天的 SF 检测和术后第 1、4 和 7 天的 D-二聚体检测均有用。然而，在接受达肝素钠治疗的患者中，仅术后第 7 天的 D-二聚体检测对 DVT 筛查有用。
给予达肝素钠后，SF 和 D-二聚体检测诊断 DVT 的准确性降低。对于接受达肝素钠治疗的患者，可能需要一种新的 DVT 诊断策略。
