Prediction of Venous Thromboembolism after Total Knee Arthroplasty Using Blood Coagulation-Fibrinolysis Markers: A Review

Hideaki Watanabe, Hirokazu Inoue, Akira Murayama, Shinya Hayasaka, Katsushi Takeshita, Ichiro Kikkawa


AIM: To account for changes in blood coagulation-fibrinolysis using blood markers after total knee arthroplasty with and without venous thromboembolism, and to determine the etiology of postoperative venous thromboembolism after total knee arthroplasty.

MATERIALS AND METHODS: A systematic literature search was conducted during November and December 2014. The electronic databases searched were PubMed, MEDLINE®, and Cochrane Library. English only and no data restriction were used. The search keywords were total knee arthroplasty AND venous thromboembolism, deep vein thrombosis, pulmonary embolism AND D-dimer, SFMC, PAI-1 appearing in the title, abstract, or keyword fields. Eight articles were identified, and the full texts of these articles were read and analyzed for validity in blood coagulation-fibrinolysis markers with vs. without venous thromboembolism after total knee arthroplasty.

RESULTS: Only D-dimer level has been a useful blood coagulation-fibrinolysis marker in the detection of venous thromboembolism after total knee arthroplasty since the 1990s. However, the D-dimer cutoff value varies from 3 to 10μg/mL and sensitivity and specificity vary from 68% to 54.5% and from 94.4% to 90%, respectively. A recent study reported that the level of fibrin degradation products of leukocyte elastase released from activated leukocytes, e-XDP, was significantly elevated in patients with venous thromboembolism and noted that the sensitivity and specificity, both 75%, might be clinically important for a cutoff value of 8.2U/mL.

CONCLUSION: D-dimer and e-XDP levels are significantly elevated in patients with venous thromboembolism after total knee arthroplasty. However, their clinical importance remains low.


Venous thromboembolism; Knee arthroplasty, total; Blood coagulation-fibrinolysis marker, Multidetector computed tomography

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