Abstract
Soluble fibrin (SF) and D-dimer are considered to be useful for the diagnosis of thrombosis; however, the efficacy of the diagnosis of deep vein thrombosis (DVT) after orthopaedic surgery by SF and D-dimer is still not well established. The present study was designed to evaluate the efficacy of SF and D-dimer in the diagnosis of DVT after orthopaedic surgery. The plasma concentrations of SF and D-dimer were measured in 99 patients following orthopaedic surgery. The plasma concentrations of D-dimer and SF in patients undergoing orthopaedic surgery were markedly high in comparison to healthy volunteers, and these markers were increased after surgery. The plasma concentrations of D-dimer were significantly higher in patients with DVT than in those without DVT at days 4, 7, 10 and 14, and those of SF were significantly higher in patients with DVT than in those without DVT at days 1, 4 and 14. A receiver operating characteristic (ROC) analysis of SF and D-dimer for diagnosis of DVT after surgery generated an ROC curve that showed SF to be better than D-dimer at day 1, while D-dimer was better than SF at day 4. In addition, less than 7.2 μg/ml of D-dimer or 3.6 μg/ml of SF at day 1 after surgery, or less than 7.0 μg/ml of D-dimer at day 4 excluded DVT. These findings suggest that the D-dimer and SF are useful for the diagnosis and exclusion of DVT after orthopaedic surgery.
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Wada H, Sakuragawa N. Are fibrin-related markers useful for the diagnosis of thrombosis? Semin Thromb Hemost. 2008;34:33–8. doi:10.1055/s-2008-1066021.
Wada H, Kobayashi T, Abe Y, Hatada T, Yamada N, Sudo A, et al. Elevated levels of soluble fibrin or D-dimer indicate high risk of thrombosis. J Thromb Haemost. 2006;4:1253–8. doi:10.1111/j.1538-7836.2006.01942.x.
Linkins LA, Bates SM, Ginsberg JS, Kearon C. Use of different D-dimer levels to exclude venous thromboembolism depending on clinical pretest probability. J Thromb Haemost. 2004;2:1256–60. doi:10.1111/j.1538-7836.2004.00824.x.
Le Gal G, Bounameaux H. Diagnosing pulmonary embolism: running after the decreasing prevalence of cases among suspected patients. J Thromb Haemost. 2004;2:1244–6. doi:10.1111/j.1538-7836.2004.00795.x.
Kline JA, Mitchell AM, Kabrhel C, Richman PB, Courtney DM. Clinical criteria to prevent unnecessary diagnostic testing in emergency department patients with suspected pulmonary embolism. J Thromb Haemost. 2004;2:1247–55. doi:10.1111/j.1538-7836.2004.00790.x.
Wada H, Sakuragawa N, Shiku H. Hemostatic molecular markers before onset of disseminated intravascular coagulation in leukemic patients. Semin Thromb Hemost. 1998;24:293–7. doi:10.1055/s-2007-995857.
Lehman CM, Wilson LW, Rodgers GM. Analytic validation and clinical evaluation of the STA LIATEST immunoturbidimetric D-dimer assay for the diagnosis of disseminated intravascular coagulation. Am J Clin Pathol. 2004;122:178–84. doi:10.1309/X4YN001GU51NGG9Y.
Wada H, Sase T, Matsumoto T, Kushiya F, Sakakura M, Mori Y, et al. Increased soluble fibrin in plasma from disseminated intravascular coagulation. Clin Appl Thromb Hemost. 2003;9:233–40. doi:10.1177/107602960300900308.
Tanigawa M, Wada H, Minamikawa K, Wakita Y, Nagaya S, Mori T, et al. Decreased protein C inhibitor after percutaneous transluminal coronary angioplasty in patients with acute myocardial infarction. Am J Hematol. 1995;49:1–5. doi:10.1002/ajh.2830490102.
Saito Y, Wada H, Yamamuro M, Inouue A, Shimura M, Hiyoyama K, et al. Changes of plasma hemostatic markers during percutaneous transluminal coronary angioplasty in patients with chronic coronary artery disease. Am J Hematol. 1999;61:238–42. doi:10.1002/(SICI)1096-8652(199908)61:4<238::AID-AJH3>3.0.CO;2-8.
Wada H, Kaneko T, Ohiwa M, Tanigawa M, Hayashi T, Tamaki S, et al. Increased levels of vascular endothelial cell markers in thrombotic thrombocytopenic purpura. Am J Hematol. 1993;44:101–5. doi:10.1002/ajh.2830440206.
Taylor FB Jr, Toh CH, Hoots WK, Wada H, Levi M. Towards definition, clinical and laboratory criteria, and a scoring system for disseminated intravascular coagulation. Thromb Haemost. 2001;86:1327–30.
Ota S, Wada H, Nobori T, Kobayashi T, Nishio M, Nishioka Y, et al. Diagnosis of deep vein thrombosis by plasma-soluble fibrin or D-dimer. Am J Hematol. 2005;79:274–80. doi:10.1002/ajh.20396.
Nomura H, Wada H, Mizuno T, Katayama N, Abe Y, Noda M, et al. Negative predictive value of D-dimer for diagnosis of venous thromboembolism. Int J Hematol. 2008;87:250–5.
Nieuwenhuizen W. A reference material for harmonization of D-dimer assays. Thromb Haemost. 1997;77:1031–3.
Dempfle CE, Zips S, Ergül H, Heene DL, the FACT study group. The fibrin assay comparison trial (FACT). Thromb Haemost. 2001;85:671–8.
Brass EP, Forman WB, Edwards RV, Lindan O. Fibrin formation: the role of fibrinogen–fibrin monomer complex. Thromb Haemost. 1976;36:37–48.
Quinlan DJ, Eikelboom JW, Dahl OE, Eriksson BI, Sidhu PS, Hirsh J. Association between asymptomatic deep vein thrombosis detected by venography and symptomatic venous thromboembolism in patients undergoing elective hip or knee surgery. J Thromb Haemost. 2007;5:1438–43. doi:10.1111/j.1538-7836.2007.02571.x.
Piovella F, Wang CJ, Lu H, Lee K, Lee LH, Lee WC, et al. Deep-vein thrombosis rates after major orthopedic surgery in Asia: an epidemiological study based on postoperative screening with centrally adjudicated bilateral venography. J Thromb Haemost. 2005;3:2664–70. doi:10.1111/j.1538-7836.2005.01621.x.
Agnelli G, Haas S, Ginsberg JS, Krueger KA, Dmitrienko A, Brandt JT. A phase II study of the oral factor Xa inhibitor LY517717 for the prevention of venous thromboembolism after hip or knee replacement. J Thromb Haemost. 2007;5:746–53. doi:10.1111/j.1538-7836.2007.02436.x.
Colwell CW Jr, Berkowitz SD, Davidson BL, Lotke PA, Ginsberg JS, Lieberman JR, et al. Comparison of ximelagatran, an oral direct thrombin inhibitor, with enoxaparin for the prevention of venous thromboembolism following total hip replacement: a randomized, double-blind study. J Thromb Haemost. 2003;1:2119–30. doi:10.1046/j.1538-7836.2003.00368.x.
Matsuda M, Terukina S, Yamazumi K, Maekawa H, Soe G. A monoclonal antibody that recognizes the NH2-terminal conformation of fragment D. In: Fibrinogen 4, Current basic and clinical aspects, Matsuda M, Iwanaga S, Takada A, Henschen A, editors. Amsterdam: Excerpta Medica; 1990. pp. 43–8.
Soe G, Kohno I, Inuzuka K, Itoh Y, Matsuda M. A monoclonal antibody that recognizes a neo-antigen exposed in the E domain of fibrin monomer complexed with fibrinogen or its derivatives: its application to the measurement of soluble fibrin in plasma. Blood. 1996;88:2109–17.
Goldstein BJ, Mushlin AI. Use of a single thyroxine test to evaluate ambulatory medical patients for suspected hypothyroidism. J Gen Intern Med. 1987;2:20–4. doi:10.1007/BF02596245.
Tsuji A, Wada H, Matsumoto T, Abe Y, Ota S, Yamada N, et al. Elevated levels of soluble fibrin in patients with venous thromboembolism. Int J Hematol. 2008;88:448–53. doi:10.1007/s12185-008-0173-5.
Wells PS, Anderson DR, Rodger M, Forgie M, Kearon C, Dreyer J, et al. Evaluation of D-dimer in the diagnosis of suspected deep-vein thrombosis. N Engl J Med. 2003;349:1227–35. doi:10.1056/NEJMoa023153.
Turpie AG, Bauer KA, Eriksson BI, Lassen MR. Fondaparinux vs enoxaparin for the prevention of venous thromboembolism in major orthopedic surgery: a meta-analysis of 4 randomized double-blind studies. Arch Intern Med. 2002;162:1833–40. doi:10.1001/archinte.162.16.1833.
Acknowledgments
This study was supported in part by research grants from the Japanese Ministry of Health, Labour and Welfare, the Japanese Ministry of Education, Culture, Sports, Science and Technology and the Mie University COE Fund.
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Sudo, A., Wada, H., Nobori, T. et al. Cut-off values of D-dimer and soluble fibrin for prediction of deep vein thrombosis after orthopaedic surgery. Int J Hematol 89, 572–576 (2009). https://doi.org/10.1007/s12185-009-0323-4
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DOI: https://doi.org/10.1007/s12185-009-0323-4