Associations between venous thromboembolism onset, D-dimer, and soluble fibrin monomer complex after total knee arthroplasty.
Associations between venous thromboembolism onset, D-dimer, and soluble fibrin monomer complex after total knee arthroplasty.
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DOI：
10.1186/s13018-015-0315-4
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发表时间：
2015-11-10
影响因子：
2.6
通讯作者：
Mochida J
中科院分区：
文献类型：
--
作者：
Mitani G;Takagaki T;Hamahashi K;Serigano K;Nakamura Y;Sato M;Mochida J
预防和早期发现下肢关节置换术后静脉血栓栓塞症(VTE)是非常重要的。本研究的目的是探讨微创全膝关节置换术(MIS-TKA)后VTE与止血指标的关系。我们对50例(55膝)行单侧人工关节置换术的患者进行了回顾性研究，定期测定D-二聚体和可溶性纤维蛋白单体复合体(SFMC)的浓度，并进行超声检查。评估有症状和无症状VTE的发展、深静脉血栓形成(DVT)的位置、SFMC和D-二聚体浓度的变化，以及止血标志物与VTE发病的相关性。26例(47%)患者有无症状的远端深静脉血栓，但无近端深静脉血栓、肺栓塞或有症状的深静脉血栓。术后第1天(POD1d)检测到DVT 16例，POD3型6例，POD5型3例(不包括同一部位不同天数的同一DVT)。DVT的发生与POD1SFMC浓度和POD3D-二聚体浓度显著相关。发生深静脉血栓形成(DVT+)和未发生深静脉血栓形成(DVT−)的患者术后各时间点的D-二聚体浓度无显著差异。DVT+和DVT−患者之间的sFMC浓度仅在POD1d有所不同。分析每个止血标志物，无论是在正常浓度范围内还是在正常浓度范围外，D-二聚体浓度与每个时期的DVT发病之间没有显著的相关性。SFMC浓度与POD1、POD3的DVT发病有显著相关性。D-二聚体阳性(+)和/或SFMC+与DVT发病在POD1和POD3之间也有显著相关性。D-二聚体+和/或SFMC+对POD1有更好的特异性，对POD1和POD3的阳性预测价值高于SFMC+。SFMC浓度是早期发现DVT的有效止血指标。仅D-二聚体浓度作为DVT早期检测的止血标志物的价值有限。同时测量D-二聚体和SFMC浓度可能是比单独测量SFMC浓度更敏感的诊断工具。
Prevention and early detection of venous thromboembolism (VTE) is important after arthroplasty of the lower limb. The purpose of this study was to investigate the associations between VTE and hemostatic markers after minimally invasive total knee arthroplasty (MIS-TKA). We performed a retrospective study of 50 patients (55 knees) who underwent primary unilateral MIS-TKA with periodic determination of D-dimer and soluble fibrin monomer complex (SFMC) concentrations and with ultrasonography. The development of symptomatic and asymptomatic VTE, location of deep venous thrombosis (DVT; proximal or distal), changes in SFMC and D-dimer concentrations, and correlations between hemostatic markers and VTE onset were evaluated. Twenty-six patients (47 %) had an asymptomatic distal DVT, but none had proximal DVT, pulmonary embolism, or symptomatic DVT. DVT was detected at postoperative day 1 (POD1) in 16 patients, POD3 in six, and POD5 in three (excluding detections of the same DVT in the same position on different days). DVT onset correlated significantly with SFMC concentration on POD1 and with D-dimer concentration on POD3. The D-dimer concentration did not differ significantly between patients who developed DVT (DVT+) and those who did not (DVT−) at each postoperative time. SFMC concentration differed between DVT+ and DVT− patients only on POD1. Analysis of each hemostatic marker classified as either within or outside the normal concentration range showed no significant correlations between D-dimer concentration and DVT onset at each period. There were significant correlations between SFMC concentrations and DVT onset on POD1 and POD3. There were also significant correlations between D-dimer positive (+) findings and/or SFMC+ findings and DVT onset on POD1 and POD3. D-dimer+ and/or SFMC+ findings had better specificity on POD1 and a positive predictive value on POD1 and POD3 compared with SFMC+ alone. SFMC concentration is an effective hemostatic marker for early detection of DVT. D-dimer concentration alone has limited value as a hemostatic marker for early detection of DVT. Measurement of both D-dimer and SFMC concentrations might be a more sensitive diagnostic tool than measuring SFMC concentration alone.