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

AIM: To account for changes in blood coagulation-fibrinolysis using\ud blood markers after total knee arthroplasty with and without venous\ud thromboembolism, and to determine the etiology of postoperative\ud venous thromboembolism after total knee arthroplasty.\ud MATERIALS AND METHODS: A systematic literature search\ud was conducted during November and December 2014. The\ud electronic databases searched were PubMed, MEDLINE®, and\ud Cochrane Library. English only and no data restriction were used.\ud The search keywords were total knee arthroplasty AND venous\ud thromboembolism, deep vein thrombosis, pulmonary embolism AND\ud D-dimer, SFMC, PAI-1 appearing in the title, abstract, or keyword\ud fields. Eight articles were identified, and the full texts of these articles\ud were read and analyzed for validity in blood coagulation-fibrinolysis\ud markers with vs. without venous thromboembolism after total knee\ud arthroplasty.\ud RESULTS: Only D-dimer level has been a useful blood coagulationfibrinolysis\ud marker in the detection of venous thromboembolism\ud after total knee arthroplasty since the 1990s. However, the D-dimer\ud cutoff value varies from 3 to 10μg/mL and sensitivity and specificity\ud vary from 68% to 54.5% and from 94.4% to 90%, respectively. A\ud recent study reported that the level of fibrin degradation products of leukocyte elastase released from activated leukocytes, e-XDP, was\ud significantly elevated in patients with venous thromboembolism and\ud noted that the sensitivity and specificity, both 75%, might be clinically\ud important for a cutoff value of 8.2U/mL.\ud CONCLUSION: D-dimer and e-XDP levels are significantly\ud elevated in patients with venous thromboembolism after total knee\ud arthroplasty. However, their clinical importance remains low