Does Prophylactic Administration of Edoxaban Increase D-Dimer Levels after Total Hip Arthroplasty?

Kawai, Toshiyuki; Kuroda, Yutaka; Goto, Koji; Matsuda, Shinya

doi:10.3390/jcm8050678

Cited by 5 publications

(5 citation statements)

References 29 publications

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“…When evaluating the D-dimer levels, surgeons must consider other possible influencing factors such as patient obesity, use of anticoagulants, and the role of different infecting organisms [ 16 , 22 , 23 ]. While it is known that patients with obesity have a 2–4-fold risk for PJI [ 24 , 25 ], obesity might also affect D-dimer levels which questions the use of D-dimer in this patient subgroup.…”

Section: Discussionmentioning

confidence: 99%

Comparing the Diagnostic Value of Serum D-Dimer to CRP and IL-6 in the Diagnosis of Chronic Prosthetic Joint Infection

Ackmann

Möllenbeck

Gosheger

et al. 2020

JCM

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Introduction: D-dimer is a diagnostic criterion for periprosthetic joint infection (PJI) of the Musculoskeletal Infection Society (MSIS) in 2018. The aim of this study was to evaluate the serum D-dimer values in comparison to C-reactive protein (CRP) and interleukin-6 (IL-6) for the diagnosis of PJI. Materials and Methods: We included 119 patients (50 women, 69 men; 71 knees, 48 hips) undergoing revision arthroplasty with preoperative assessment of CRP, IL-6, and serum D-dimer. Cases were classified as infected or aseptic based on the MSIS criteria of 2018. Receiver operating curves and Youden’s index were used to define an ideal cut-off value and sensitivity and specificity for the individual parameters, and respective combinations were calculated using cross-tables. Results: The median D-dimer level (2320 vs. 1105 ng/mL; p < 0.001), the median CRP level (4.0 vs. 0.5 mg/dL; p < 0.001), and the median IL-6 level (21.0 vs. 5.0 pg/mL; p < 0.001) were significantly higher in the group of PJI compared to the group with aseptic failure. The calculated optimal cut-off values were 2750 ng/mL (AUC 0.767) for D-dimer, 1.2 mg/dL (AUC 0.914) for CRP, and 10.0 pg/mL (AUC 0.849) for IL-6. D-dimer showed a sensitivity of 38% and specificity of 94%, whereas the CRP and IL-6 had sensitivities of 88% and 76%, and specificities of 87% and 92%, respectively. Conclusion: In comparison with CRP and IL-6, serum D-dimer showed low sensitivity and specificity in our cohort. While CRP and IL-6 combination had the highest sensitivity, a combination of Il-6 and D-dimer or CRP and IL-6 had the highest specificity.

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Section: Discussionmentioning

confidence: 99%

Comparing the Diagnostic Value of Serum D-Dimer to CRP and IL-6 in the Diagnosis of Chronic Prosthetic Joint Infection

Ackmann

Möllenbeck

Gosheger

et al. 2020

JCM

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“…40 A similar result was found in patients receiving edoxaban, a direct Xa oral inhibitor, as a thromboprophylactic in the postoperative period of a THA. 41 The use of edoxaban was correlated with a high D-dimer level on POD 21, but not on PODs 7 and 14. This could be due to hemostasis being delayed by anticoagulants, which may result in a higher amount of local hemorrhage and thus fibrin degradation is prolonged.…”

Section: D-dimer Testing In Patients On Anticoagulation Therapymentioning

confidence: 92%

“…This could be due to hemostasis being delayed by anticoagulants, which may result in a higher amount of local hemorrhage and thus fibrin degradation is prolonged. 41 Rivaroxaban is also a direct Xa oral inhibitor. To identify the sensitivity of D-dimer in predicting DVT in the first 4 days of the postoperative period in patients receiving a TKA while on rivaroxaban 10 mg PO as prophylaxis for the first 14 postoperative days, 200 enrolled patients received regardless of the D-dimer testing also bilateral ascending venography of the legs, which was carried out on the next day after the last dose of rivaroxaban, or earlier if symptomatic.…”

Section: D-dimer Testing In Patients On Anticoagulation Therapymentioning

confidence: 99%

<p>Deep Venous Thrombosis in a Patient with a Moderate Pretest Probability and a Negative D-Dimer Test: A Review of the Diagnostic Algorithms</p>

Al-Khafaji¹,

Schierbeck²

2020

JBM

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Modern diagnostic strategies of venous thromboembolism (VTE) have been developed. In this review, the diagnostic algorithms for deep-vein thrombosis (DVT) and their parameters are discussed individually in the context of reporting a case of DVT in a 43-yearold Caucasian female with a moderate pretest probability stratified by Wells' score and a negative high quality D-dimer test. The patient was on treatment with Xarelto (rivaroxaban), 20 mg PO daily at the time of presentation. The diagnosis was verified through a complete lower limb ultrasound (US). This case highlights the diagnostic challenges and pitfalls of the current algorithms, especially those seen in a subgroup of patients such as patients with cancer, pregnancy, recurrent VTE or are on anticoagulation therapy at the time of presentation. The diagnosis of DVT is less plausible in a patient who is on anticoagulation therapy, but physicians should be aware of such a possibility. Physicians should also know in advance the numerous clinically relevant limitations of D-dimer testing before interpreting the results. Unifying the current diagnostic strategies, modifying the current Wells' score and using the protocol of a whole-leg compression US instead of the limited US protocol are among the several cautious suggestions that have been proposed based on this review to possibly decrease the incidence of missed DVT.

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“…However, we had to extend the patient's preoperative waiting time to conduct anticoagulation therapies if the patient had DVT of lower extremities. The diagnosis of DVT is mainly through plasma markers, vascular ultrasound and venography ( 9 ). Although venography is the gold standard for the diagnosis of venous thromboembolism ( 10 ), its application is limited in clinical work ascribed to the invasiveness and unrepeatability.…”

Section: Introductionmentioning

confidence: 99%

Risk factors and new diagnostic index for deep venous thrombosis of lower extremities in elderly patients with traumatic femoral neck fracture

Chen

Liu

et al. 2023

Front. Surg.

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PurposeTo determine the incidence and risk factors of deep vein thrombosis (DVT) of lower extremities at admission in elderly Chinese patients with femoral neck fracture, and to establish and evaluate a new DVT predictor based on these risk factors.MethodsPatients who were hospitalized from January 2018 to December 2020 at three independent centers were reviewed. According to the results of lower extremities vascular ultrasound at admission, they were divided into DVT group and non-DVT group. Single and multivariate logistic regression analysis were applied to identify independent risk factors for DVT occurrence, and then a prediction formula for DVT based on the risk factors was developed. The new predictive index of DVT was calculated by the formula. Receiver operating characteristic (ROC) curve analysis was used to determine the diagnostic value of different factors and the new predictive index.ResultsThere were 203 elder patients were included in the final analysis after application of the exclusion criteria. Thirty seven patients (18.2%) were diagnosed as DVT by ultrasound, including 33 patients (89.2%) of peripheral type, 1 patient (2.7%) of central type and 3 patients (8.1%) of mixed type.Multivariate logistic regression analysis showed that four factors including injured side, hemoglobin, fibrinogen, d-dimer were the independent risk factors for the incidence of DVT. On this basis, a new formula for DVT predictive factor was constructed: New predictive index = 0.895 * injured side (right = 1, left = 0) + 0.899 * hemoglobin (<109.5 g/L = 1, > 109.5 g/L = 0) + 1.19 * fibrinogen (>4.24 g/L = 1, < 4.24 g/L = 0) + 1.221* d-dimer (>2.4 mg/L = 1, < 2.4 mg/L = 0). The AUC value of this new developed index was 0.735.ConclusionsThis work showed that the incidence of DVT in elderly patients with femoral neck fracture in China was high at admission. New DVT predictive value can be used as an effective diagnosis strategy for evaluation of thrombosis at admission.

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Does Prophylactic Administration of Edoxaban Increase D-Dimer Levels after Total Hip Arthroplasty?

Cited by 5 publications

References 29 publications

Comparing the Diagnostic Value of Serum D-Dimer to CRP and IL-6 in the Diagnosis of Chronic Prosthetic Joint Infection

Comparing the Diagnostic Value of Serum D-Dimer to CRP and IL-6 in the Diagnosis of Chronic Prosthetic Joint Infection

<p>Deep Venous Thrombosis in a Patient with a Moderate Pretest Probability and a Negative D-Dimer Test: A Review of the Diagnostic Algorithms</p>

Risk factors and new diagnostic index for deep venous thrombosis of lower extremities in elderly patients with traumatic femoral neck fracture

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