D-DIMER PLASMA MEASUREMENT IN PATIENTS UNDERGOING MAJOR HIP-SURGERY -USE IN THE PREDICTION AND DIAGNOSIS OF POSTOPERATIVE PROXIMAL VEIN-THROMBOSIS

Plasma D-Dimer (DD), a highly sensitive marker of venous thromboemboli sm, was measured with an ELISA assay preoperatively and on the 12th po stoperative day in 173 patients undergoing major hip surgery (78 elect ive arthroplasties and 95 operations for fractures). Proximal deep ven ous thrombosis (DVT) was detected by systematic compression venous ult rasonography on the 12th postoperative day in 12 (7%) patients. In one additional case, proximal DVT was diagnosed by venography, Preoperati ve DD level was significantly higher in patients with fracture than in patients undergoing elective arthroplasty. At a cutoff of 500 mu g/L as determined by ROC curve analysis, the sensitivity, specificity, pos itive and negative predictive values of the pre-operative DD concentra tion for the development of subsequent proximal DVT were 93%, 23%, 36% and 96%, respectively. The diagnostic exclusion value of the DD measu rement on the 12th postoperative day was similar but for a cutoff of 2 000 mu g/L. These data suggest that plasma DD measurement might be use ful to predict and diagnose proximal DVT following major hip surgery.