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Analysis of Measured D-dimer Levels for Detection of Deep Venous Thrombosis and Pulmonary Embolism After Spinal Surgery.
MedLine Citation:
PMID:  20975598     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
STUDY DESIGN: A retrospective clinical study.
OBJECTIVES: To show the prevalence of deep venous thrombosis (DVT) and pulmonary embolism (PE) after spinal surgery using a D-dimer assay followed by screening with computed tomographic (CT) pulmonary angiography and CT venography.
SUMMARY OF BACKGROUND DATA: A few studies on DVT development after spinal surgery have been reported.
METHODS: A complete surveillance examination for DVT and PE was conducted in 88 patients who underwent spinal surgery [male patients, 48; female patients, 40; average age at operation, 62.4 y (range, 17 to 85 y)] through a D-dimer assay combined with CT pulmonary angiography and CT venography. The operation levels were the cervical spine (21 cases), the thoracic spine (16 cases), and the lumbar spine (51 cases). We adopted a D-dimer cut-off point of 10 μg/mL, and classified the patients into high D-dimer (HD; D-dimer level ≥10 μg/mL) and low D-dimer (LD; D-dimer level <10 μg/mL) groups.
RESULTS: Nine (10.2%) patients showed D-dimer levels of ≥10 μg/mL (HD group); of these, 5 patients (5.7%) had DVT. Two (2.2%) of the 5 DVT patients had PE. DVT was evident in 1 (6.2%) of the 16 patients who underwent thoracic procedures and 4 (7.8%) of the 51 patients who underwent lumbar procedures. Statistical comparison between the HD (excluding 5 patients with DVT or PE) and LD groups showed a significant difference in intraoperative blood loss between the groups (P=0.02).
CONCLUSIONS: The D-dimer assay was useful in predicting DVT development. A D-dimer level of ≥10 μg/mL is considered to be a risk factor for thromboembolic disease after spinal surgery. False-positive cases of thromboembolic disease preclude the use of this assay as a stand-alone test for DVT diagnosis. CT venography and CT pulmonary angiography are recommended to confirm thromboembolic disease.
Authors:
Toyomi Yoshiiwa; Masashi Miyazaki; Chikahiro Takita; Ichiro Itonaga; Hiroshi Tsumura
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of spinal disorders & techniques     Volume:  24     ISSN:  1539-2465     ISO Abbreviation:  J Spinal Disord Tech     Publication Date:  2011 Jun 
Date Detail:
Created Date:  2011-05-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101140323     Medline TA:  J Spinal Disord Tech     Country:  United States    
Other Details:
Languages:  eng     Pagination:  E35-9     Citation Subset:  IM    
Affiliation:
Department of Orthopaedic Surgery, Faculty of Medicine, Oita University, Japan.
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