Measurement of plasma D-dimer is not useful in the prediction or diagnosisof postoperative deep vein thrombosis in patients undergoing total knee arthroplasty

Plasma D-dimer, a highly sensitive marker of venous thromboembolism, was me asured using an enzyme-linked immunosorbent assay pre-operatively, on the t hird postoperative day, and at the time of phlebography in 118 patients und ergoing elective total knee arthroplasty. Deep venous thrombosis (DVT) was detected using systematic bilateral phlebography between the eighth and 12t h postoperative day in 47 (39.8%) patients. D-dimer plasma concentrations d id not differ between patients who had DVT and those who had no DVT, either pre-operatively (n = 118, P = 0.63) or at the time of phlebography (n = 11 1, P = 0.70). On the third postoperative day, D-dimer concentration was sig nificantly higher (P < 0.01) in the patients who had DVT (median 3270 mu g/ l, range 1156-9996, n = 47) than in those who did not (2287 mu g/l, 685-706 2, n = 64). However, receiver operating characteristics curve analysis did not provide any useful cutoff values that would allow individual diagnoses to be made. In conclusion, the results of the present study suggest that pl asma measurement of D-dimer concentration is of no value for predicting, di agnosing or ruling out DVT in patients undergoing total knee arthroplasty. (C) 1998 Lippincott Williams & Wilkins.