Serum D-dimer should not be used in the diagnosis of venous thromboembolism within 28 days of total knee replacement surgery
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 re...
| Main Authors: | , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2020-09-01
|
| Series: | Knee Surgery & Related Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s43019-020-00068-x |
| _version_ | 1818995868553969664 |
|---|---|
| author | Ethan Toner Tobenna Oputa Heather Robinson Olivia McCabe-Robinson Andrew Sloan |
| author_facet | Ethan Toner Tobenna Oputa Heather Robinson Olivia McCabe-Robinson Andrew Sloan |
| author_sort | Ethan Toner |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-20T21:20:41Z |
| format | Article |
| id | doaj.art-84c87428e0294c24b7a1c2e1b0e91abd |
| institution | Directory Open Access Journal |
| issn | 2234-2451 |
| language | English |
| last_indexed | 2024-12-20T21:20:41Z |
| publishDate | 2020-09-01 |
| publisher | BMC |
| record_format | Article |
| series | Knee Surgery & Related Research |
| spelling | doaj.art-84c87428e0294c24b7a1c2e1b0e91abd2022-12-21T19:26:18ZengBMCKnee Surgery & Related Research2234-24512020-09-013211510.1186/s43019-020-00068-xSerum D-dimer should not be used in the diagnosis of venous thromboembolism within 28 days of total knee replacement surgeryEthan Toner0Tobenna Oputa1Heather Robinson2Olivia McCabe-Robinson3Andrew Sloan4Trauma & Orthopaedic Department, Royal Victoria HospitalTrauma & Orthopaedic Department, Royal Blackburn HospitalTrauma & Orthopaedic Department, Royal Blackburn HospitalTrauma & Orthopaedic Department, Royal Blackburn HospitalTrauma & Orthopaedic Department, Royal Blackburn HospitalAbstract 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.http://link.springer.com/article/10.1186/s43019-020-00068-xTotal knee replacementD-dimerVenous ThromboembolismDeep vein thrombosis (DVT) |
| spellingShingle | Ethan Toner Tobenna Oputa Heather Robinson Olivia McCabe-Robinson Andrew Sloan Serum D-dimer should not be used in the diagnosis of venous thromboembolism within 28 days of total knee replacement surgery Knee Surgery & Related Research Total knee replacement D-dimer Venous Thromboembolism Deep vein thrombosis (DVT) |
| title | Serum D-dimer should not be used in the diagnosis of venous thromboembolism within 28 days of total knee replacement surgery |
| title_full | Serum D-dimer should not be used in the diagnosis of venous thromboembolism within 28 days of total knee replacement surgery |
| title_fullStr | Serum D-dimer should not be used in the diagnosis of venous thromboembolism within 28 days of total knee replacement surgery |
| title_full_unstemmed | Serum D-dimer should not be used in the diagnosis of venous thromboembolism within 28 days of total knee replacement surgery |
| title_short | Serum D-dimer should not be used in the diagnosis of venous thromboembolism within 28 days of total knee replacement surgery |
| title_sort | serum d dimer should not be used in the diagnosis of venous thromboembolism within 28 days of total knee replacement surgery |
| topic | Total knee replacement D-dimer Venous Thromboembolism Deep vein thrombosis (DVT) |
| url | http://link.springer.com/article/10.1186/s43019-020-00068-x |
| work_keys_str_mv | AT ethantoner serumddimershouldnotbeusedinthediagnosisofvenousthromboembolismwithin28daysoftotalkneereplacementsurgery AT tobennaoputa serumddimershouldnotbeusedinthediagnosisofvenousthromboembolismwithin28daysoftotalkneereplacementsurgery AT heatherrobinson serumddimershouldnotbeusedinthediagnosisofvenousthromboembolismwithin28daysoftotalkneereplacementsurgery AT oliviamccaberobinson serumddimershouldnotbeusedinthediagnosisofvenousthromboembolismwithin28daysoftotalkneereplacementsurgery AT andrewsloan serumddimershouldnotbeusedinthediagnosisofvenousthromboembolismwithin28daysoftotalkneereplacementsurgery |