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Serum D-dimer seen as ineffective for diagnosing DVT after TJA
In the acute postoperative period, recently published results showed serum D-dimer was an ineffective screening test for the diagnosis of symptomatic deep venous thrombosis in patients undergoing total joint arthroplasty.
Researchers measured serum D-dimer preoperatively, perioperatively and postoperatively at 2 weeks and 6 weeks in 177 adult patients aged 40 years to 88 years who underwent primary total hip arthroplasty (THA) or total knee arthroplasty (TKA) with a Charlson Comorbidity Index of less than three.
Among both THA and TKA groups, results showed D-dimer measurements peaked at 2 weeks postoperatively and resolved at the 6-week time point by 54.3% for patients in the TKA group and by 76.6% for patients in the THA group. Researchers found 92% of patients who underwent THA and 100% of patients who underwent TKA had serum D-dimer measurements higher than the 0.40 μg/mL institutional threshold for a positive quantitative test at 6 weeks postoperatively. Neither groups reported symptomatic deep venous thrombosis during the study period, according to results. – by Casey Tingle
Disclosures: An reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.
Perspective
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Because many total joint arthroplasty (TJA) patients experience leg swelling in the postoperative period, a simple diagnostic test would be most helpful. The D-dimer test has been used clinically in this situation as a serum marker for deep venous thrombosis (DVT), and this study demonstrates it is an ineffective screening tool in this situation. Although other authors have questioned the efficacy of the D-dimer test, the authors report the D-dimer level can remain elevated for 6 weeks postoperatively.
Prophylactic anticoagulation for DVT after TJA remains a debated topic, especially between internists and orthopedic surgeons. Because this study addressed only symptomatic DVT and did not assess for the presence of asymptomatic DVT, this topic will continue to be controversial.