Does Preprocedural Age-Adjusted D-dimer Testing Have Any Advantage Before Percutaneous Pain Intervention for Detecting Potential Thrombovascular Events in Older Adults?

Abstract Background: Venous Thromboembolism (VTE) is a serious reason of morbidity and mortality in elderly adults. Ordinary pre-procedural scanning can simplify beforetime detection of asymptomatic or subclinical Thrombovascular Events. Age-Adjusted D-dimer Testing (AADT) may aid in identifying Potential Thrombovascular Events (PTVE) in patients established for Percutaneous Interventional Pain Procedures (PIPP). Objective: The aim of this study was to evaluate the relationship between age- adjusted d-dimer testing value and potential thrombovascular events in preparation for percutaneous interventional pain procedures. Study Design: A retrospective study Setting: This retrospective study included 131 patients over 18 years of age who underwent d-dimer testing for percutaneous interventional pain management. Methods: We conducted a retrospective study of patients aged 18 years and older who underwent transforaminal epidural steroid injection, interlaminar epidural steroid injection, caudal epidural steroid injection, cervical epidural steroid injection, facet median branch radiofrequency therapy, or ganglion impar block for lumbar disc herniation, cervical disc herniation, or coccydynia between May 2022 and February 2023 and underwent pre-intervention laboratory evaluations (including D-dimer testing). Data collected included demographic variables (age, sex, occupation), reason for admission, pain scores, comorbid systemic diseases, presence of thromboembolic symptoms, history of venous thrombosis, anticoagulant use, smoking and alcohol use, obesity, COVID-19 infection history and timing, vaccination status, vaccine type, date of last vaccination, laboratory parameters (D-dimer, fibrinogen, platelet count, leukocyte count, hemoglobin level, renal and liver function tests), respiratory symptoms, presence of Homans’ sign, specialist consultations, details of initiated anticoagulant therapy (if any), type of PIPP, hospital admission, intensive care unit (ICU) admission, and need for mechanical ventilation. Patients were also contacted by telephone six months after their procedure date to assess mortality outcomes. Statistical analyses used Mann-Whitney U tests, chi-square tests, and post-hoc analyses with Bonferroni correction. Results: Of 143 patients scanned, 131 (mean age 64.2 ± 14.0 years) were added in the study. Higher age-adjusted D-dimer values were significantly correlated with elderly age (p=0.00014), greater comorbidity burden (p=0.0025), and the presence of PTVE (p<0.000001). No significant correlation was peered with COVID-19 vaccination status or number of vaccine doses. Conclusion: AADT can be utilized as a cost-effective noninvasive monitoring tool to determine PTVE in patients more than 60 years of age, with two or more comorbidities, and who are planned for PIPP, especially if the value is high up1.66 µg/mL. Limitations: Limitations of this study include the relatively small sample size and the retrospective study design.