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Serum D-dimer should not be used in the diagnosis of venous thromboembolism within 28?days of total knee replacement surgery

Knee Surgery & Related Research 2020년 32권 1호 p.49 ~ 49
Toner Ethan, Oputa Tobenna, Robinson Heather, McCabe-Robinson Olivia, Sloan Andrew,
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 ( Toner Ethan ) - Royal Victoria Hospital Trauma and Orthopaedic Department
 ( Oputa Tobenna ) - Royal Blackburn Hospital Trauma and Orthopaedic Department
 ( Robinson Heather ) - Royal Blackburn Hospital Trauma and Orthopaedic Department
 ( McCabe-Robinson Olivia ) - Royal Blackburn Hospital Trauma and Orthopaedic Department
 ( Sloan Andrew ) - Royal Blackburn Hospital Trauma and Orthopaedic Department

Abstract


Background: Serum D-dimer is frequently used to rule out a diagnosis of venous thromboembolism (VTE), a recognised complication following total knee replacement (TKR). TKR is known to cause a rise in D-dimer levels, reducing its specificity. Previous studies have demonstrated that D-dimer remains elevated within 10?days of TKR and therefore should be avoided. The aim of this study was to determine whether serum D-dimer tests are clinically appropriate in identifying VTE when performed within 28?days of TKR.

Methods: Case notes for patients who had a serum D-dimer test performed for clinically suspected VTE at ≥ 28?days following TKR were retrospectively reviewed for a 6-year period. Demographics, D-dimer result, time after surgery and further radiological investigations were recorded.

Results: Fifty patients underwent D-dimer tests at ≥ 28?days following surgery (median 60?days, range 29?266); 48 of these patients had a positive result. Of these, five had confirmed VTE on radiological investigations. Serum D-dimer was raised in 96% of the patients. Only 10.42% of these patients had confirmed VTE. No patients with negative D-dimers had confirmed VTE.

Conclusions: These findings suggest that serum D-dimer remains raised for at least 28?days and possibly considerably longer following TKR. Serum D-dimer should not be used in patients with clinically suspected VTE within this period because of its unacceptably low specificity of 4.44% and positive predictive value of 10.42%, which can lead to a delay in necessary further radiological investigations, waste of resources and unnecessary exposure to harm.

키워드

Total knee replacement; D-dimer; Venous Thromboembolism; Deep vein thrombosis (DVT)

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