抄録
Objective : The purpose of this study was to investigate the D-dimer values for the screening of postoperative PE in patients with RA who underwent total hip or knee arthroplasty, and the relationship between the plasma D-dimer level and CRP and ESR as RA activity markers.
Methods : There were 51 RA and 11 OA patients. Venous blood for CRP and ESR estimation was taken preoperatively; that for D-dimer estimation was taken preoperatively and on the fifth day postoperatively. Plasma D-dimer levels were measured by latex agglutination. PE was diagnosed by arterial pO2 level and perfusion/ventilation scan.
Results : (1) Preoperative D-dimer levels, were significantly higher in patients with RA than in those with OA. After surgery, D-dimer levels were elevated in both, but postoperative levels were not significantly correlated. (2) We detected PE in 8 of 62 patients (12.9%), and only one of them, who underwent TKA for OA, developed symptomatic PE. Her plasma D-dimer level was significantly higher postoperatively than preoperatively. But there was no tendency for plasma D-dimer levels in asymptomatic PE patients to be higher than in non-PE patients. (3) A highly significant correlation existed between CRP, ESR, and preoperative plasma D-dimer levels in RA patients.
Conclusion : The ability of coagulative and fibrinolytic molecular markers to diagnose PE and DVT has been examined, and the usefulness of FDP D-dimer has been appreciated by many authors. In RA patients, we need to estimate plasma D-dimer levels not only postoperatively but also preoperatively, and combining estimation of plasma D-dimer levels with the clinical features evaluation method, low-invasive diagnosis and rapid treatment should be possible.
