Preoperative screening for venous thromboembolism in total knee arthroplasty

The purpose of this study is to investigate the availability of the D-dimer as a screening marker, the factors affecting on the value of the D-dimer, and the patient's background with the deep vein thrombosis (DVT) and pulmonary thromboembolism (PTE) before total knee arthroplasty (TKA) prospective trial. The total of 85 patients scheduled for TKA from March 2004 to Aril 2007 were enrolled under the criteria excluding the revison surgery and the medication of anticoagulant. There were 20 men and 65 women with a mean age of 73 years-old (range, 52-89). All patients were measured the D-dimer preoperatively. If the value was more than 1.0 μg/ml, the multidetector-CT (MD-CT) examination was followed to determined the diagnosis for DVT and/or pulmonary embolism (PE). In addition, six clinical factors including the age, sex, body mass index (BMI), disease, heart function, and walking ability were examined in order to analyze their influences on the value of D-dimer and the formation of DVT/PE. The mean value of D-dimer was 2.5±2.7 μg/ml and 71 patients (83.5%) had the value more than 1.0 μg/ml. The incidence of DVT/PE was 9.4% (1.2-15.0 μg/ml). There were no symptomatic cases. No clinical factors had significant differences in the occurrence of DVT/PE. Our findings demonstrated that the preoperative screening for DVT/PE using the MD-CT selectively in patients with a high value of D-dimer was not always available. Additional anticoagulant treatment, therefore, may be necessary for the prevention of DVT/PE after TKA. (author)