D-dimer testing cannot rule out thromboembolism after major lower extremity arthroplasties and thromboprophylaxis treatment.

Abstract

Our previous study showed, for the first time, that a guideline-recommended thromboprophylactic strategy reduced the prevalence of venous thromboembolism (VTE) including venous thromboembolism and pulmonary embolism after arthroplasties of the major lower extremities, such as total hip arthroplasty (THA) or total or partial knee arthroplasty (TPKA), to 4.4 %. In this retrospective study, we examined the diagnostic value of D-dimer for VTE and try to confirm the low prevalence of VTE after THA or TPKA. This was a retrospective study including 380 procedures of 361 patients who underwent elective 129 TPKA or 251 THA, as well as multidetector computed tomography (MDCT) on postoperative day 7 with D-timer testing to screen for VTE. In 303 of 380 procedures, D-timer testing was performed on the same day as MDCT. The antithrombotic prophylaxes included medical and mechanical therapy and early ambulation. The prevalence of VTE was 4.5 % (17 cases) (95 % confidence interval 2.4-6.6 %). The D-dimer level was significantly greater in patients with VTE than in those without (13.4 ± 11.1 vs 10.1 ± 6.5 μg/mL). At the lowest cut-off value of 4.0 μg/mL, D-dimer testing ruled out VTE in only 26 of 303 cases with 1 (6 %) false negative result. The low incidence of postoperative VTE with the strict anticoagulation strategy was confirmed in this validation study. D-dimer testing is not useful for excluding VTE postoperatively in patients who undergo THA or TPKA.