title: Elevated d-Dimer Is Not Predictive of Symptomatic Deep Venous Thrombosis After Total Joint Arthroplasty.
abstract: Serum d-dimer is a common screening test for symptomatic deep venous thrombosis (DVT) after total joint arthroplasty. This study characterized the longitudinal resolution of d-dimer measurements after total hip and knee arthroplasty (THA/TKA) over a 6-week period. The authors hypothesized that serum d-dimer would not return to baseline or be below the institutional threshold for a positive test at 6 weeks after uncomplicated total joint arthroplasty, suggesting that quantitative d-dimer has limited clinical utility for postoperative DVT screening.
  
  
  
  An institutional review board-approved retrospective cohort study was conducted with consecutive patients between January 2013 and June 2015. A total of 177 adult patients aged 40-88 years who underwent a primary hip or knee arthroplasty with a Charlson Comorbidity Index <3 were included in the study. Serum d-dimer was measured at preoperative, perioperative, and postoperative 2- and 6-week time points.
  
  
  
  d-dimer measurements peaked 2 weeks postoperatively for both TKA and THA. At the 6-week time point, the peak serum d-dimer measurement resolved by 54.3% and 76.6% for TKA and THA, respectively. At 6 weeks after operation, 92% of THA patient and 100% of TKA patients had serum d-dimer measurements higher than the institutional threshold (0.40 μg/mL) for a "positive" quantitative test. No symptomatic DVTs were reported for the THA and TKA cohorts during the study period.
  
  
  
  The results suggest that serum d-dimer is an ineffective screening test for the diagnosis of symptomatic DVT in the acute postoperative period. The authors propose that extravascular fibrinolysis, a process essential for wound healing, has a crucial role in the prolonged elevation of serum d-dimer in the postoperative period.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: An
authors.affiliation: Department of Orthopedics, Vanderbilt University, Nashville, Tennessee.
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Engstrom
authors.affiliation: The Medical University of South Carolina, Charleston, South Carolina.
authors.forename: William K
authors.initials: WK
authors.lastname: Oelsner
authors.affiliation: Vanderbilt University School of Medicine, Nashville, Tennessee.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Benvenuti
authors.affiliation: Department of Orthopedics, Vanderbilt University, Nashville, Tennessee.
authors.forename: Gregory G
authors.initials: GG
authors.lastname: Polkowski
authors.affiliation: Department of Orthopedics, Vanderbilt University, Nashville, Tennessee; Department of Pediatrics, Vanderbilt University, Nashville, Tennessee; Department of Pathology, Vanderbilt University, Nashville, Tennessee; Department of Pharmacology, Vanderbilt University, Nashville, Tennessee.
authors.forename: Jonathan G
authors.initials: JG
authors.lastname: Schoenecker
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D007719:Knee Joint / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000097:blood* / Q000209:etiology; D011184:Postoperative Period; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020246:Venous Thrombosis / Q000097:blood* / Q000209:etiology
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: d-dimer; deep vein thrombosis; hip; knee; total joint arthroplasty; ultrasound