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. 2020 Sep 22;32(1):49.
doi: 10.1186/s43019-020-00068-x.

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

Ethan Toner  1 , Tobenna Oputa  2 , Heather Robinson  2 , Olivia McCabe-Robinson  2 , Andrew Sloan  2
Affiliations

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

Ethan Toner et al. Knee Surg Relat Res. .

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.

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

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Serum D-dimer result plotted against time after surgery. Cases highlighted in black had confirmed VTE on radiological investigation. The dotted line shows the level where D-dimer result was considered positive
See this image and copyright information in PMC

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