The Evaluation of Fibrin-Related Markers for Diagnosing or Predicting Acute or Subclinical Venous Thromboembolism in Patients Undergoing Major Orthopedic Surgery

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D-dimer is a biomarker of thrombosis and recently been considered to predict a poor outcome in patients with infectious diseases. Plasma D-dimer levels were measured in critically ill patients to examine their relationship with the poor outcome. The plasma D-dimer levels were markedly higher in the patients with various underlying disease especially venous thromboembolism in comparison to those without severe underlying diseases. The plasma D-dimer levels in non-survivors were significantly higher than those in survivors. In a receiver operating characteristic analysis, the area under the curve was high for the disseminated intravascular coagulation (DIC) score, the D-dimer value, and the prothrombin time-international normalize ratio (PT-INR). Adequate cut-off values for predicting the outcome were 3 as follows: DIC score, 3 points; D-dimer, 4.2 mg/L; and PT-INR, 1.08. D-dimer, which is a biomarker for thrombosis, is increased in various underlying diseases and predicts a poor outcome.

“…The normal median (25th-75th percentile) value and negative predictive values for DVT of D-dimer were 0.30 μg/ml (0.10-0.50 μg/ml) and 1.2 μg/ml, respectively. 16 …”

Section: Methodsmentioning

confidence: 99%

Elevated D-Dimer Levels Predict a Poor Outcome in Critically Ill Patients

Ichkawa

Wada

Ezaki

et al. 2020

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“…8 However, during the early phase of postoperative joint surgery, approximately 30% to 50% patients in Western countries and approximately 10% to 30% of patients in Asian countries have small thrombus without any clinical symptoms. 1,9–13 These asymptomatic small emboli tend to grow and be fatal if the patients do not receive appropriate precautionary measures. 3,14,15 Joint arthroplasty can lead to an unbalance between coagulation and fibrinolysis, 6,16 and the disturbances in coagulation and fibrinolysis occur before the formation of emboli.…”

Section: Introductionmentioning

confidence: 99%

“…3,14,15 Joint arthroplasty can lead to an unbalance between coagulation and fibrinolysis, 6,16 and the disturbances in coagulation and fibrinolysis occur before the formation of emboli. 1,9,17–19 Hence, the coagulation and fibrinolysis indices may become abnormal prior to imagological examination. Therefore, it is necessary to identify accurate biomarkers that reflect the changes in coagulation and fibrinolysis in order to predict the occurrence of postoperative VTE, especially symptomatic and fatal pulmonary embolism.…”

Section: Introductionmentioning

confidence: 99%

Clinical Impact of Coagulation and Fibrinolysis Markers for Predicting Postoperative Venous Thromboembolism in Total Joint Arthroplasty Patients

Cheng

Liu

et al. 2019

One common complication after joint arthroplasty is venous thromboembolism (VTE). Therefore, it is essential to measure the changes in coagulation and fibrinolysis in order to predict VTE among patients who underwent joint arthroplasty. This study aimed to identify potential useful biomarkers for prognosing to VTE. This was a prospective cohort study enrolling 83 patients who underwent joint arthroplasty. The levels of d-dimer, thrombin–antithrombin complex (TAT), plasmin–α2-antiplasmin complex (PIC), soluble thrombomodulin, and tissue plasminogen activator inhibitor complex were measured on day 0 (before surgery) and days 1, 3, and 6 after surgery. Ultrasound examination was used to diagnose VTE on preoperative day 0 and postoperative day 6. A total of 35 patients developed VTE after surgery. Patients with VTE exhibited significantly higher levels of d-dimer and TAT on postoperative days 3 and 6 (all P < .05). The area under curves (AUC) of receiver operating characteristic (ROC) were 0.65 and 0.68 and 0.68 and 0.74 for d-dimer and TAT levels on postoperative days 3 and 6, respectively. The level of TAT/PIC ratio on postoperative day 6 was significantly increased among patients with VTE compared to non-VTE patients ( P < .0001). In addition, the AUC of ROC, cutoff level, sensitivity, specificity, positive-predictive value, and negative-predictive value of TAT/PIC ratio were 0.78, 4.03 ng/TU, 97.14%, 33.33%, 51.52%, and 94.12%, respectively. The high sensitivity and negative predictive value of TAT/PIC ratio make it a potential prognostic index for diagnosing VTE during the early phase of postoperative joint arthroplasty.

“…31 Thus, the increased d -dimer levels in SSc suggest a thrombotic state. 32 A d -dimer level of ≥1 μg/mL has been proposed as a hallmark for a prethrombotic state. 33 In the present study, plasma levels of ADAMTS-13 were lower and plasma levels of VWF and VWFpp were higher in patients with SSc having high D-dimer levels (≥1 μg/mL) than in those with low d -dimer levels (<1 μg/mL).…”

Section: Discussionmentioning

confidence: 99%

The Plasma Levels of ADAMTS-13, von Willebrand Factor, VWFpp, and Fibrin-Related Markers in Patients With Systemic Sclerosis Having Thrombosis

Habe

Wada

Higashiyama

et al. 2017

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This study aimed to examine the hemostatic abnormalities in patients with systemic sclerosis (SSc) and the relationship between these abnormalities and thrombotic events (THEs), focusing on the difference in diffuse cutaneous SSc (dcSSc) and limited cutaneous SSc (lcSSc). The plasma levels of ADAMTS-13 (a disintegrin-like and metalloproteinase with thrombospondin type 1 motifs 13), von Willebrand factor (VWF), VWF propeptide (VWFpp), d-dimer, and soluble fibrin (SF) were measured in 233 patients with SSc. The relationship between their levels and organ involvement, including THEs and interstitial lung disease (ILD), was evaluated. The plasma levels of VWF and VWFpp were significantly elevated and ADAMTS-13 activity was significantly decreased in patients with SSc compared to healthy participants. The VWFpp in dcSSc was significantly higher than in lcSSc. Twelve patients with SSc were complicated with acute THE, and 25 patients with SSc were complicated with past THE. The plasma levels of d-dimer and SF were significantly elevated in patients with SSc having THE. The plasma levels of VWF and VWFpp were significantly elevated in patients with SSc having ILD. The plasma levels of d-dimer were elevated in patients with SSc having other connective tissue diseases (CTDs). The plasma levels of ADAMTS-13 were significantly decreased and VWF, VWFpp, and SF were increased in patients with a d-dimer level of ≥1 μg/mL. Systemic sclerosis carries a high risk of THE, especially in patients with other CTDs. Plasma hemostasis-related markers are closely related to ILD and THE. These markers are important as markers of organ involvement as well as THE.