D-Dimer in the Diagnosis of Deep Vein Thrombosis Following Total Hip and Knee Replacement: A Prospective Study

Abstract

INTRODUCTIONThe merit of using D-dimer estimations in patients following total hip and knee replacement has been previously questioned. A survey of radiology protocols in 70 hospitals ascertained that the test continues to be mandatory in 51 prior to formal radiological investigation of suspected deep vein thrombosis (DVT) in this patient population.PATIENTS AND METHODS In this study, D-dimer levels were measured pre-operatively and during the first 7 days following primary total hip and knee replacement to estimate the range of normal values in these patients. RESULTS All 78 patients were ultrasonographically shown to be clear of DVT. D-Dimer levels were significantly raised in all patients at all measurements during the first week. Levels after total knee replacement were higher than after total hip replacement. Comparison was made with an age-matched group who had a proven DVT. There was no difference in D-dimer levels between patients with or without a DVT. CONCLUSIONS The use of this test in this patient group is a waste of resource and merely delays appropriate radiological investigation and treatment.

Does Endovenous Laser Ablation Induce Endothelial Damage at the Saphenofemoral Junction?

“…31 In surgical patients, hemostatic markers are poor predictors of DVT but are estimators of the degree of surgical trauma. [23][24][25][32][33][34] In this study, F1 1 2 and D-dimer increased continuously during EVLA, reaching statistical significance for both parameters at the endpoint of laser ablation. Mean baseline levels of F1 1 2 were within normal range in anticubital blood but were high in iliofemoral blood, most probably due to insertion of the CVC.…”

“…In surgical patients, the increase in F1 1 2 and D-dimer reflects the degree of tissue trauma associated with the surgical procedure. [23][24][25] In this study, (s) P-selectin and sTM were monitored as markers of endothelial and platelet activation and F1 1 2 and D-dimer as surrogate markers for surgical trauma.…”

Diagnostic value of platelet‑derived microparticles in pulmonary thromboembolism: A population‑based study

“…A previous study has shown that the guidelines recommending clinical probability and D-dimer assessment as the initial screening tests for venous thromboembolism diagnosis in low-risk patients are underused (36). Many risk factors of venous thromboembolism also increase the D-dimer level, including old age, cardiovascular disease, surgery, tumor, infections, and tissue necrosis (10,11). Therefore, we suspect that the combination of D-dimer and PMPs may not improve the diagnostic efficiency of PTE in clinical practice.…”

“…It is known that a D-dimer level lower than 500 ng/ml in the peripheral blood can exclude the diagnosis of PTE (9). Although D-dimer has a high sensitivity in the diagnosis of PTE, its specificity (30 to 40%) is poor because it can be influenced by various factors, such as increasing age, cardiovascular disease, surgery, tumor, infection, and tissue necrosis (10,11). Therefore, novel non-invasive biomarkers with high sensitivity and specificity are urgently needed.…”

The great deception: tranexamic acid and extensive pulmonary emboli

“…There is good evidence to delineate the causes of a false-positive D-dimer such as sepsis with DIC,7 aortic dissection,8 and recent surgery/trauma,9 but little regarding the causes of a false-negative D-dimer.…”