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Fondaparinux Prevents DVT, but Not PE in Total Knee Arthroplasty WithMDCT Analysis.*Kenji Fukunaga - Dept. of Orthopaedic Surgery, Osaka City University Graduate School ofMedicine - Osaka, JapanHiroyoshi Iwaki - Osaka City University Medical School - osaka, japanYukihide Minoda - Osaka - Osaka, JapanHirotsugu Ohashi - Department of Orthopaedic Surgery, Saiseikai Nakatsu Hospital - Osaka,JapanFumiaki Inori - Saisekai Nakatsu Hospital - Osaka city, JapanYoshiaki Okajima - Osaka Saiseikai Nakatsu Hospital - Osaka, JapanHideyuki Tashima - Saiseikai Nakatsu Hospital - Osaka, JapanIntroduction*Email: goodprice7777@yahoo.co.jpDeep venous thrombosis (DVT) and pulmonary embolism (PE) are serious complications afterjoint arthroplasty. We assessed DVT and PE after total knee arthroplasty (TKA) by 64-slicemulti-detector row CT (MDCT), which can simultaneously detect DVT and PE within 1 minute.The first purpose of this study was to assess the prevalence of PE and DVT after TKA.Fondaparinux is a synthetic pentasaccaharide and highly selective inhibitor of activated FactorXa. The second purpose of this study was therefore to assess the prevention of PE and DVT byusing fondaparinux after TKA.Materials and MethodsWe investigated 72 patients (9 male, 63 female) (88 knees; 79 OA, 9 RA) operated on betweenMay 2006 and March 2009. Forty-four knees in the non Fondaparinux (nonFP) group equippedwith a venous foot pump on both legs until walking and 44 knees in the FP group that receiveda subcutaneous injection of Fondaparinux and the venous foot pump were not significantlydifferent between age, gender, and BMI. Compression stockings were routinely used for 2weeks after walking in both groups. At day 7, patients underwent MDCT to detect DVT andPE, and the results were evaluated by a radiologist.ResultsIn the nonFP group, DVT was revealed in 10 patients (22.7%), whereas PE occurred in 5patients (11.4%). In the FP group, DVT was revealed in 4 patients (9.1%), whereas PE occurredin 6 patients (13.6%). The incidence of DVT in the FP group tended to be less than the nonFPgroup (p = 0.08). All patients were asymptomatic. Bleeding occurred in 7 patients (15.9%) inthe FP group, whereas there was no bleeding in the nonFP group. We confirmed that a cutoffvalue of 8.0 μg/mL for D-dimer was highly sensitive (86.7%), but had low specificity (45.2%),for the diagnosis of DVT. For the diagnosis of PE, D-dimer had low sensitivity (72.7%) andlow specificity (41.6%).ConclusionOur results indicate that prophylaxis with a venous foot pump and Fondaparinux is a verysuccessful strategy for prophylaxis against DVT in TKA, but not for PE. We concluded that D-dimer level on post operative day 7 appears to be an indication of the no occurrence of DVTafter TKA. But D-dimer levels were not an indication of PE after TKA.file:///E|/ISTA2010-Abstracts.htm[12/7/2011 3:15:47 PM]