Postoperative D-dimer-based Screening for Venous Thromboembolism after Total Hip Arthroplasty: A Retrospective Cohort...

Venous thromboembolism (VTE), including deep vein thrombosis (DVT) and pulmonary embolism (PE), is a serious complication after total hip arthroplasty (THA). Although D-dimer testing is widely used for VTE screening, there is no consensus regarding its optimal cutoff value or screening strategy after THA. The purpose of this study was to evaluate the validity of a postoperative VTE screening strategy based on a D-dimer cutoff value of 10.0 μg/mL measured at 1 week after unilateral THA.

This retrospective observational study included 1,651 unilateral THAs at a single institution between April 2007 and March 2023. Serum D-dimer levels were routinely measured at 1 week postoperatively. Patients with D-dimer levels ≥10.0 μg/mL underwent contrast-enhanced computed tomography (CT) to evaluate for DVT and/or PE. Demographic, clinical, and perioperative variables were analyzed, and multivariable regression analyses were performed to identify factors associated with postoperative D-dimer levels and VTE.

Postoperative D-dimer levels ≥10.0 μg/mL were observed in 343 hips (20.8%), among which 31 hips were diagnosed with VTE. Of these, 22 hips had isolated DVT, seven had isolated PE, and two had both DVT and PE. Appropriate anticoagulation therapy was initiated in all diagnosed cases, and no fatal or clinically severe VTE events occurred. Patients with VTE had significantly higher D-dimer levels compared to those without VTE. Multivariable analysis demonstrated that female sex, advanced age, diabetes treated with medication, and greater intraoperative blood loss were independently associated with higher postoperative D-dimer levels.

A postoperative D-dimer-based screening strategy incorporating contrast-enhanced CT for patients with D-dimer levels ≥10.0 μg/mL at 1 week after THA appeared to be feasible and clinically acceptable, with no severe thromboembolic events observed in this cohort of 1,651 hips. However, further studies are warranted to determine the optimal cutoff value for postoperative D-dimer screening.