Elevated d-Dimer Is Not Predictive of Symptomatic Deep Venous Thrombosis After Total Joint Arthroplasty

An, Thomas; Engstrom, Stephen M.; Oelsner, William K.; Benvenuti, Michael A.; Polkowski, Gregory G.; Schoenecker, Jonathan G.

doi:10.1016/j.arth.2016.02.059

Cited by 20 publications

(15 citation statements)

References 25 publications

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“…The preoperative D-dimer evaluation is usually not routinely performed in varicose vein patients. Moreover, when performed, its diagnostic and prediction values were often questioned [32][33][34]. Similarly to these observations, we could not confirm the potential prediction value of the preoperative D-dimer levels in our study cohort, even when the elevated D-dimers were preoperatively noticed in a significant number of patients.…”

Section: Discussioncontrasting

confidence: 65%

Venous Thromboembolism Prophylaxis and Thrombotic Risk Stratification in the Varicose Veins Surgery—Prospective Observational Study

Wołkowski¹,

Wołkowski

Urbanek

2020

JCM

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Background: An invasive phlebological treatment is still not free from complications such as thrombosis. As in other surgical populations, not only the treatment modality, but also patient condition-related venous thromboembolism (VTE) risk factors matter. The current protocols used in varicose vein surgery centers are based mostly on individual risk assessment as well as on an implementation and extrapolation of general surgery VTE prophylaxis guidelines. In the presented study, the efficacy of routine VTE pharmacological thromboprophylaxis in patients undergoing saphenous varicose vein surgery was prospectively evaluated. In the result assessment, VTE risk factor evaluation and Caprini score results were included; however, due to the limited size of the projected study group, as well as expected limited deep vein thrombosis (DVT) prevalence in this clinical scenario, it was not possible to perform the validation of the Caprini model efficacy in the projected study model. Methods: In the study, 141 patients undergoing saphenous vein stripping and miniphlebectomy in spinal anesthesia were included. In all of the patients, VTE risk factors (including Caprini score evaluation) were assessed, and the routine thromboprophylaxis with enoxaparin 40 mg for 10 days was used. The venous ultrasounds were undertaken before the surgery and on the 10th and 30th day after surgery. The study endpoint was the presence of symptomatic or asymptomatic DVT confirmed in the imaging study. The study safety endpoint was major bleeding occurrence intraoperatively or within 30 days after surgery. Results: The presence of a postoperative DVT was diagnosed in five cases (3.5%) In all of these cases, only distal DVT was confirmed. Despite extensive saphenous varicose vein surgery with stripping and miniphlebectomy performed in nontumescent but spinal anesthesia, no proximal lower leg episode was diagnosed. Three out of five DVT cases were diagnosed on day 10 postoperative control, while a further two were confirmed in the ultrasound examination performed 30 days after procedure. No clinically documented pulmonaly embolism (PE) as well as no bleeding episodes were noticed. Among the factors related to the statistically significant higher DVT occurrence, the results of the Caprini score were identified with odds ratio (OR) = 2.04 (95% CI = (0.998; 4.18)). Another factor that became statistically significant in terms of the higher postoperative DVT prevalence was the reported Venous Clinical Severity Score (VCSS) results (OR = 1.98; 95% CI (1.19; 3.26)). In the multiple logistic regression analysis, the patient age (OR = 0.86; 95% CI (0.75–0.99)), Caprini score evaluation results (OR = 4.04; 95% CI (1.26–12.9)) and VCSS results (OR = 2.4; 95% CI (1.23–4.7)) were of statistical significance as predictors for postoperative DVT occurrence, with a p value of 0.029 for age, and p = 0.017 and p = 0.009 for Caprini score results and VCSS results, respectively. Due to the confirmed limited number of the DVT events in our study cohort, as well as the descriptive and explorative nature of the achieved results, the final clinical potential and significance of the identified parameters, including Caprini score rate and VCSS rate, should be interpreted with caution and studied in the further trials in these clinical settings. Conclusion: All the patients undergoing varicose vein surgery should undergo VTE risk evaluation based on the individual assessment. In VTE risk evaluation, patient and surgical procedure characteristics based on the factors included into the Caprini score but also on specific chronic venous disease-related factors should be taken into consideration. Further studies are needed to propose an objective and validated VTE risk assessment model, as well as a validated antithrombotic prophylaxis protocol in this particular patient group.

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Section: Discussioncontrasting

confidence: 65%

Venous Thromboembolism Prophylaxis and Thrombotic Risk Stratification in the Varicose Veins Surgery—Prospective Observational Study

Wołkowski¹,

Wołkowski

Urbanek

2020

JCM

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“…Accurate, rapid diagnosis and valid prediction of DVT during the perioperative period are essential due to its significant impact on morbidity and mortality [ 4 ]. Previous studies have established D-dimer as an effective biomarker for DVT [ 5 , 6 ], however, another study conducted by Thomas et al did not support the predictive value of D-dimer in symptomatic DVT after total joint arthroplasty [ 7 ]. The occurrence of thrombosis can be ascribed to the imbalance between coagulation and fibrinolytic factors [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Plasminogen activator inhibitor-1: a risk factor for deep vein thrombosis after total hip arthroplasty

et al. 2018

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BackgroundThe onset of deep vein thrombosis (DVT) in patients after total hip arthroplasty (THA) may expand or enlarge and subsequently lead to significant mortality. The objective of this study was to investigate potential risk factors for DVT in patients after THA.MethodsEligible patients with hip joint diseases who were scheduled for unilateral primary THA at our hospital were prospectively included into this study. The demographic and clinical features, preoperative plasma biomarkers were detailed, recorded, and compared. The multiple logistic regression analysis was used to evaluate potential risk factors for DVT.ResultsA total of 214 subjects were enrolled into our study cohort for the final analysis, and 23 of them have suffered DVT with an incidence of 9.5%. The performance of logistic regression analysis showed that preoperative expression of plasminogen activator inhibitor-1 (PAI-1) was an independent risk factor for the onset of DVT in patients after THA (OR 1.18, 95% CI 1.04–1.29; p = 0.011).ConclusionsOur study indicated preoperative plasma PAI-1 expression as an independent risk factor for DVT in patients who underwent THA.

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“…D-dimer was utilized to predict VTE although the results remained controversial. In the study by An, [ 27 ] the authors characterized the longitudinal resolution of D-dimer after primary THA and TKA over a 6-week period, and found 92% of THA and 100% of TKA patients had a positive test of serum D-dimer (higher than threshold) without any symptomatic DVTs. In the current study, we also found the level of D-dimer did not fall back to the normal range before discharge, and no DVTs were detected (Table 2 and Fig.…”

Section: Discussionmentioning

confidence: 99%

“…[ 30 ] The main reason may be related to wound healing and inflammation, because the deposition and subsequent clearance of fibrin from the extravascular space have been proven to be essential element of tissue remodeling. [ 27 , 31 , 32 ] Moreover, plasminogen or plasmin via fibrinolysis play a vital role in the inflammation. Plasmin exhibits a broad spectrum of proinflammatory responses by binding and activating monocytes, neutrophils, platelets, and endothelial cells, and complement-releasing lipid mediators and cytokines.…”

Section: Discussionmentioning

confidence: 99%

Plasma D-dimer and FDP are promising biomarkers to predict perioperative fibrinolysis and bleeding following primary total joint arthroplasty

Xie

Pei

2021

Medicine

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Perioperative bleeding is associated with postoperative hyperfibrinolysis caused by surgical trauma in the setting of total hip and knee arthroplasty (THA/ TKA). The study aimed to clarify the dynamics of postoperative fibrinolytic activity and the values of fibrin degeneration products and thromboelastography (TEG) to guide precisive antifibrinolytic therapy. Forty three patients undergoing primary unilateral THAs and 40 TKAs were included to the prospective observational cohort study. Venous blood sample at different time points (preoperative, intraoperative, postoperative 6 hours, 12 hours, 24 hours, 48 hours) were drawn to test D-dimer, fibrin (-ogen) degradation products (FDP) and TEG. The TEG parameters associated with coagulation (R, K, α, MA, and CI) and fibrinolysis (estimate percent lysis and Ly30) were all in normal range although had a higher level than preoperative time ( P < .05). The postoperative levels of D-dimer and FDP were higher than preoperative level ( P < .05). The dynamics of D-dimer and FDP presented a bimodal pattern, which peaked at 6 hours postoperatively, then remained and decreased until 24 hours, but would rebound at 48 hours postoperatively with smaller amplitude. Moreover, FDP 6h ( P = .028), D-Dimer 6h ( P = .044), FDP 12h ( P = .009), D-dimer 12h ( P = .007), and FDP 48h ( P = .016) were all correlated with total blood loss on POD3. FDP and D-dimer were effective and practical markers for prediction of acute postoperative fibrinolytic activity, which peaked at 6 hours after end of surgery and would maintain for at least 24 hours.

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Elevated d-Dimer Is Not Predictive of Symptomatic Deep Venous Thrombosis After Total Joint Arthroplasty

Cited by 20 publications

References 25 publications

Venous Thromboembolism Prophylaxis and Thrombotic Risk Stratification in the Varicose Veins Surgery—Prospective Observational Study

Venous Thromboembolism Prophylaxis and Thrombotic Risk Stratification in the Varicose Veins Surgery—Prospective Observational Study

Plasminogen activator inhibitor-1: a risk factor for deep vein thrombosis after total hip arthroplasty

Plasma D-dimer and FDP are promising biomarkers to predict perioperative fibrinolysis and bleeding following primary total joint arthroplasty

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