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

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: 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 400 ng/ml. Of the SARS-CoV-2 IgG-positive patients, 257 (83.71%) had d -dimer levels 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 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.