The Dynamics of D-dimer Level Fluctuation in Patients after the Cemented and Cementless Total Hip and Total Knee Replacement

Bytniewski, Piotr

doi:10.31579/2641-0427/005

Cited by 4 publications

(5 citation statements)

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“…There was a trough on the third day after surgery. Bytniewski et al 27 investigated the dynamics of D-dimer level after the cemented and cementless total hip and total knee replacement, and found a similar tendency, which was consistent with our research. The reasons for the elevation of D-dimer after surgery may be due to surgical trauma, anaesthesia interference, intraoperative blood loss and blood transfusion, the activation of coagulation system by implants, and the participation of various inflammatory mediators in the body to promote coagulation under stress.…”

Section: Discussionsupporting

confidence: 92%

The Impact of D-Dimer on Postoperative Deep Vein Thrombosis in Patients with Thoracolumbar Fracture Caused by High-Energy Injuries

Wang

et al. 2022

Clin Appl Thromb Hemost

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Objective To investigate the dynamic variation of D-dimer and to evaluate the efficacy and accuracy of D-dimer level in patients with thoracolumbar fractures caused by high-energy injuries. Methods A total of 121 patients with thoracolumbar fractures caused by high-energy injuries were retrospectively identified and included in this study. There were 83 males and 38 females, with an average age of 48.6 ± 11.2 years. All patients were treated with either screw fixation surgery or decompression fixation surgery. The D-dimer levels were measured 1 day before surgery and on the first, third, and fifth days after surgery. The dynamic variation of D-dimer and the effects of risk factors on D-dimer levels were analysed. A receiver operating characteristic (ROC) curve analysis was performed and the appropriate D-dimer cut-off level was determined for deep vein thrombosis (DVT) screening. Results Due to a trough on the third day, D-dimer levels grew in an unsustainable manner following surgery (P < 0.001). Patients with the operation time >120 min (P = 0.009) and those with an American Spinal Injury Association (ASIA) score A-C (P < 0.001) had higher D-dimer levels. The area under the curve of D-dimer was the greatest on the third day. Applying stratified cut-off values did not change the sensitivity, specificity and negative predictive value in the group with an operation time >120 min, and ASIA score A-C group. Conclusions D-dimer levels elevated with fluctuation in patients with thoracolumbar fractures caused by high-energy injuries after surgery. Both operation time and ASIA score had an impact on D-dimer levels. Regarding DVT diagnoses, the diagnostic value of D-dimer was highest on the third day postoperatively, and stratified cut-off values by these two factors did not show better diagnostic efficacy compared with a collective one.

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Section: Discussionsupporting

confidence: 92%

The Impact of D-Dimer on Postoperative Deep Vein Thrombosis in Patients with Thoracolumbar Fracture Caused by High-Energy Injuries

Wang

et al. 2022

Clin Appl Thromb Hemost

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“…Reducing unnecessary blood tests can also reduce costs and prevent wasting resources [22]. Previous studies to date have demonstrated that serum D-dimer testing up to 10 days after a total knee replacement should not be used as a diagnostic test [9,10]. Our study suggests that D-dimer testing is a poor choice of investigation for VTE for up to 28 days after surgery and should be avoided and replaced with more accurate radiological investigations.…”

Section: Discussionmentioning

confidence: 82%

“…Studies have demonstrated that after TKR, serum D-dimer levels remain elevated from day 0 to day 10 post-operatively [9,10], with no significant difference in D-dimer level between patients with or without a DVT from day 0 to day 10 following surgery [3,9,10]. Bytniewski et al [10] found that higher levels of serum D-dimers in the post-operative period of up to 10 days were not related to increased risk of VTE. Due to its low specificity in this period, the use of serum D-dimer within the first 10 days following TKR is not recommended as a screening tool for VTE [9].…”

Section: Introductionmentioning

confidence: 99%

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

Toner

Oputa

Robinson

et al. 2020

Knee Surg & Relat Res

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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.

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“…According to Ribera et al, the level of synovial D-dimer is higher than normal in foal infectious joint disease [34]. The results of the study done by Bytniewski et al show that the level of D-Dimer in patients with early postoperative TJA changes faster than that of ESR and CRP, and can rise rapidly and return to normal level in a short time [36]. Subsequently, the diagnostic value of D-dimer in patients with PJI began to be valued by joint surgeons.…”

Section: Discussionmentioning

confidence: 97%

Diagnostic Accuracy of D-Dimer in Periprosthetic Joint Infection: a diagnostic meta-analysis

Zhang

Sun²,

Xin

et al. 2020

Preprint

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Background: Periprosthetic joint infection (PJI) is one of the most devastating complications after total joint replacement. Up to now, the diagnosis of PJI is still in a dilemma. As a novel biomarker, whether D-Dimer is valuable in the diagnosis of PJI remains controversial. This meta-analysis attempts to determine the diagnostic accuracy of D-Dimer in PJI.Methods: Relevant literature was retrieved from PubMed, Embase, Web of Science, and Cochrane Library (from database establishment to April 2020). Literature quality was evaluated using Revman (Version 5.3). The random effect model was used in Stata version 14.0 software to combine sensitivity, specificity, likelihood ratio (LR), diagnostic odds ratio (DOR), summary receiver operating characteristic (SROC) curve and area under SROC (AUC) to evaluate the diagnostic value of overall D-Dimer for PJI. Meta regression and subgroup analysis were performed according to the threshold, the study design, the sample size, the diagnostic gold standard, the country of study, and the type of sample.Results:A total of 9 studies were included in this study, including 1592 patients. The pooled sensitivity and specificity of D-Dimer for PJI diagnosis are 0.82(95%CI, 0.72~0.89) and 0.73(95%CI, 0.58~0.83), respectively. The pooled positive likelihood ratio (PLR) and negative likelihood ratio (NLR) were 2.99 (95%CI, 1.84~4.88) and 0.25 (95%CI, 0.15~0.41), respectively. The pooled AUC and diagnostic odds ratios were 0.85 (95%CI, 0.82~0.88) and 12.20 (95% CI, 4.98~29.86), respectively.Conclusion: D-Dimer is a promising biomarker for the diagnosis of PJI, which should be used in conjunction with other biomarkers or as an adjunct to other diagnostic methods to enhance diagnostic performance.

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The Dynamics of D-dimer Level Fluctuation in Patients after the Cemented and Cementless Total Hip and Total Knee Replacement

Cited by 4 publications

References 0 publications

The Impact of D-Dimer on Postoperative Deep Vein Thrombosis in Patients with Thoracolumbar Fracture Caused by High-Energy Injuries

The Impact of D-Dimer on Postoperative Deep Vein Thrombosis in Patients with Thoracolumbar Fracture Caused by High-Energy Injuries

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

Diagnostic Accuracy of D-Dimer in Periprosthetic Joint Infection: a diagnostic meta-analysis

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