History of COVID-19 infection is not associated with increased d-dimer levels and risk of deep-vein thrombosis in total joint arthroplasty

Jungwirth-Weinberger, Anna; Bendich, Ilya; Hanreich, Carola; Gonzalez Della Valle, Alejandro; Blevins, Jason L.; Westrich, Geoffrey H.; Boettner, Friedrich

INTRODUCTION: In the acute phase of COVID-19, elevated d-dimer levels indicate a hypercoagulable state putting the patients at increased risk for venous thromboembolic disease (VTE). It is unclear, if prior COVID-19 disease increases the risk for VTE after total joint arthroplasty (TJA) and if d-dimer levels can be used to identify patients at risk. MATERIALS AND METHODS: d-Dimer levels of 313 consecutive SARS-CoV-2 IgG-positive and 2,053 -negative patients undergoing TJA between 05/20 and 12/20 were evaluated. d-Dimer levels were divided into three groups: < 200 ng/ml, 200–400 ng/ml, and > 400 ng/ml d-dimer units (DDU). 277 SARS-CoV-2 IgG-positive patients underwent a Doppler ultrasound to rule out deep-vein thrombosis (DVT) 4–6 weeks after TJA. RESULTS: d-Dimer levels did not differ significantly between SARS-CoV-2 IgG-positive and -negative patients (p value 0.53). Among SARS-CoV-2 IgG-negative patients, 1687 (82.17%) had d-dimer levels < 200 ng/ml, 256 (12.47%) between 200 and 400 ng/ml, and 110 (5.36%) > 400 ng/ml. Of the SARS-CoV-2 IgG-positive patients, 257 (83.71%) had d-dimer levels < 200 ng/ml, 34 (11.07%) between 200 and 400 ng/ml, and 16 (5.21%) > 400 ng/ml. A postoperative DVT was detected in nine patients (2.9%) in the SARS-CoV-2 IgG-positive group and a PE in one patient (0.3%). 7/229 patients with < 200 ng/ml (3.1%), 1/28 patients (3.6%) with 200–400 ng/ml and 1/9 patients (11.1%) with d-dimer levels > 400 ng/ml had a DVT or PE (p = 0.43). CONCLUSIONS: The findings of this investigation suggest there is no difference in d-dimer levels between SARS-CoV-2 IgG-positive and -negative patients undergoing TJA. Although there is a trend for increased VTE rates with increased d-dimer levels, routine d-dimer testing is not recommended based on the current data. SARS-CoV-2 IgG-positive patients have a low risk of VTE in the current study.