Top

Published in:

01-12-2022 | Ultrasound | Research

Thrombin antithrombin complex concentration as an early predictor of deep vein thrombosis after total hip arthroplasty and total knee arthroplasty

Authors: Zhencan Lin, Hao Sun, Deng Li, Zhiqing Cai, Meiyi Chen, Wenhui Zhang, Fangzhou Liu, Zhencheng Huang, Yimin Wang, Jie Xu, Ruofan Ma

Published in: BMC Musculoskeletal Disorders | Issue 1/2022

Abstract

Aim

Early predictive markers of venous thromboembolism (VTE) after total hip arthroplasty (THA)/total knee arthroplasty (TKA) remain unclear. Our study identified early predictive markers for VTE after THA/TKA.

Methods

A single-institution retrospective review study was conducted between May 2020 and April 2022 (n = 256). All patients underwent Doppler ultrasounds exam in preoperation and seventh day after surgery. Deep vein thrombosis (DVT) was defined by Doppler ultrasound of the lower extremities, which revealed thrombosis. Thrombin-antithrombin complex (TAT), thrombomodulin (TM), and plasmin-antiplasmin complex (PIC) concentration were tested from each patient’s preoperative and postoperative days 1, 4, 7, 14. These values were then accessed via receiver operating characteristic (ROC) curve analysis and further quantified the level of this risk by concentration.

Results

On postoperative day 1 (pod-1), all patients’ TAT and PIC concentrations were significantly higher than those preoperatively (p < 0.05). The levels of TAT and PIC in patients in the DVT group on pod-1 were significantly higher than those in the non-DVT group (p < 0.05). At pod-1, the TAT concentration for DVT patients was 49.47 ng/mL compared to 20.70 ng/mL for non-DVT patients, PIC was 3.72μg/mL compared to 1.65μg/mL. ROC curve analysis demonstrated that a TAT concentration of 24.3 ng/mL had a sensitivity of 87.9% and a specificity of 69.1%.

Conclusion

TAT levels on pod-1 may predict DVT early after THA/TKA, which makes it possible for early intervention to decrease the incidence of DVT.

Anderson DR, Dunbar M, Murnaghan J, Kahn SR, Gross P, Forsythe M. Aspirin or rivaroxaban for VTE prophylaxis after hip or knee arthroplasty. N Engl J Med. 2018;378(8):699. https://doi.org/10.1056/NEJMoa1712746.CrossRefPubMed

Falck-Ytter Y, Francis CW, Johanson NA, Curley C, Dahl OE, Schulman S. Prevention of VTE in orthopedic surgery patients: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl):e278S. https://doi.org/10.1378/chest.11-2404.CrossRefPubMedPubMedCentral

Wen S, Duan Q, Yang F, Li G, Wang L. Early diagnosis of venous thromboembolism as a clinical primary symptom of occult cancer: Core proteins of a venous thrombus. Oncol Lett. 2017;14(1):491. https://doi.org/10.3892/ol.2017.6175.CrossRefPubMedPubMedCentral

Akpinar EE, et al. Does thromboprophylaxis prevent venous thromboembolism after major orthopedic surgery? J Bras Pneumol. 2013;39(3):280–6. https://doi.org/10.1590/S1806-37132013000300004.CrossRefPubMedPubMedCentral

Dixon J, Ahn E, Zhou L, Lim R, Simpson D, Merriman EG. Venous thromboembolism rates in patients undergoing major hip and knee joint surgery at Waitemata District health board: a retrospective audit. Intern Med J. 2015;45(4):416. https://doi.org/10.1111/imj.12702.CrossRefPubMed

Cha SI, Lee SY, Kim CH, Park JY, Jung TH, Yi JH. Venous thromboembolism in Korean patients undergoing major orthopedic surgery: a prospective observational study using computed tomographic (CT) pulmonary angiography and indirect CT venography. J Korean Med Sci. 2010;25(1):28. https://doi.org/10.3346/jkms.2010.25.1.28.CrossRefPubMed

Leizorovicz A, Turpie AG, Cohen AT, Wong L, Yoo MC. Dans a SMART study group. Epidemiology of venous thromboembolism in Asian patients undergoing major orthopedic surgery without thromboprophylaxis. The SMART study. J Thromb Haemost. 2005;3:28–34. https://doi.org/10.1111/j.1538-7836.2004.01094.x.CrossRefPubMed

Mitani G, Takagaki T, Hamahashi K, Serigano K, Nakamura Y, Sato M. Associations between venous thromboembolism onset, D-dimer, and soluble fibrin monomer complex after total knee arthroplasty. J Orthop Surg Res. 2015;10:172. https://doi.org/10.1186/s13018-015-0315-4.CrossRefPubMedPubMedCentral

Wu JX, Qing JH, Yao Y, Chen DY, Jiang Q. Performance of age-adjusted D-dimer values for predicting DVT before the knee and hip arthroplasty. J Orthop Surg Res. 2021;16(1):82. https://doi.org/10.1186/s13018-020-02172-w.CrossRefPubMedPubMedCentral

10.

An TJ, Engstrom SM, Oelsner WK, Benvenuti MA, Polkowski GG, Schoenecker JG. Elevated d-dimer is not predictive of symptomatic deep venous thrombosis after Total joint arthroplasty. J Arthroplast. 2016;31(10):2269. https://doi.org/10.1016/j.arth.2016.02.059.CrossRef

11.

Wu CT, Chen B, Wang JW, Yen SH, Huang CC. Plasma D-dimer is not useful in the prediction of deep vein thrombosis after total knee arthroplasty in patients using rivaroxaban for thromboprophylaxis. J Orthop Surg Res. 2018;13(1):173. https://doi.org/10.1186/s13018-018-0883-1.CrossRefPubMedPubMedCentral

12.

Shi D, Xu X, Xu Z, Nakamura T, Pang Y, Yao C. P-selectin: an unpredicted factor for deep vein thrombosis after total hip arthroplasty. Biomed Res Int. 2014;2014:783967. https://doi.org/10.1155/2014/783967.CrossRefPubMedPubMedCentral

13.

Abu Assab T, Raveh-Brawer D, Abramowitz J, Naamad M, Ganzel C. The predictive value of Thromboelastogram in the evaluation of patients with suspected acute venous thromboembolism. Acta Haematol. 2020;143(3):272. https://doi.org/10.1159/000502348.CrossRefPubMed

14.

Parameswaran A, Krishnamoorthy VP, Oommen AT, Jasper A, Korula RJ, Nair SC. Is pre-operative assessment of coagulation profile with Thrombelastography (TEG) useful in predicting venous thromboembolism (VTE) following orthopaedic surgery? J Clin Orthop Trauma. 2016;7(Suppl 2):225. https://doi.org/10.1016/j.jcot.2016.08.003.CrossRefPubMedPubMedCentral

15.

Owen WG, Esmon CT. Functional properties of an endothelial cell cofactor for thrombin-catalyzed activation of protein C. J Biol Chem. 1981;256(11):5532 10;256(11):5532-5.CrossRef

16.

Lundbech M, Krag AE, Christensen TD, Hvas AM. Thrombin generation, thrombin-antithrombin complex, and prothrombin fragment F1+2 as biomarkers for hypercoagulability in cancer patients. Thromb Res. 2020;186:80. https://doi.org/10.1016/j.thromres.2019.12.018.CrossRefPubMed

17.

Schaller J, Gerber SS. The plasmin-antiplasmin system: structural and functional aspects. Cell Mol Life Sci. 2011;68(5):785. https://doi.org/10.1007/s00018-010-0566-5.CrossRefPubMed

18.

Matharu GS, Kunutsor SK, Judge A, Blom AW, Whitehouse MR. Clinical effectiveness and safety of aspirin for venous thromboembolism prophylaxis after Total hip and knee replacement: a systematic review and Meta-analysis of randomized clinical trials. JAMA Intern Med. 2020;180(3):376. https://doi.org/10.1001/jamainternmed.2019.6108.CrossRefPubMedPubMedCentral

19.

Lieberman JR, Pensak MJ. Prevention of venous thromboembolic disease after total hip and knee arthroplasty. J Bone Joint Surg Am. 1801;95(19):2013. https://doi.org/10.2106/JBJS.L.01328.CrossRef

20.

Kyrle PA, Eichinger S. Deep vein thrombosis. Lancet. 2005;365(9465):1163. https://doi.org/10.1016/S0140-6736(05)71880-8.CrossRefPubMed

21.

An V, Levy YD, Walker PM, Bruce W. Thrombosis rates using aspirin and a compression device as multimodal prophylaxis for lower limb arthroplasty in a screened population. J Clin Orthop Trauma. 2020;11(Suppl 2):S187–91. https://doi.org/10.1016/j.jcot.2018.10.007.CrossRefPubMed

22.

Lippi G, Cervellin G, Franchini M, Favaloro EJ. Biochemical markers for the diagnosis of venous thromboembolism: the past, present and future. J Thromb Thrombolysis. 2010;30(4):459. https://doi.org/10.1007/s11239-010-0460-x.CrossRefPubMed

23.

Kobayashi H, Akamatsu Y, Kumagai K, Kusayama Y, Ishigatsubo R, Mitsuhashi S. The use of factor Xa inhibitors following opening-wedge high tibial osteotomy for venous thromboembolism prophylaxis. Knee Surg Sports Traumatol Arthrosc. 2017;25(9):2929. https://doi.org/10.1007/s00167-016-4065-6.CrossRefPubMed

24.

Kitayama H, Kondo T, Sugiyama J, Kurimoto K, Nishino Y, Hirayama M. Venous thromboembolism in hospitalized patients receiving chemotherapy for malignancies at Japanese community hospital: prospective observational study. BMC Cancer. 2017;17(1):351. https://doi.org/10.1186/s12885-017-3326-1.CrossRefPubMedPubMedCentral

Title: Thrombin antithrombin complex concentration as an early predictor of deep vein thrombosis after total hip arthroplasty and total knee arthroplasty
Authors: Zhencan Lin
Hao Sun
Deng Li
Zhiqing Cai
Meiyi Chen
Wenhui Zhang
Fangzhou Liu
Zhencheng Huang
Yimin Wang
Jie Xu
Ruofan Ma
Publication date: 01-12-2022
Publisher: BioMed Central
Keywords: Ultrasound
Phlebothrombosis
Ultrasound
Thrombosis
Hip-TEP
Hip-TEP
Published in: BMC Musculoskeletal Disorders / Issue 1/2022
Electronic ISSN: 1471-2474
DOI: https://doi.org/10.1186/s12891-022-05532-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Thrombin antithrombin complex concentration as an early predictor of deep vein thrombosis after total hip arthroplasty and total knee arthroplasty

Abstract

Aim

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Aim

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2022

Chronic low back pain: a prospective study with 4 to 15 years follow-up after a multidisciplinary biopsychosocial rehabilitation program

Patient-reported outcomes following cemented versus cementless primary total knee arthroplasty: a comparative analysis based on propensity score matching

Evaluation of a collaborative ambulatory orthopedic care program for patients with hip and knee osteoarthritis: a comparative observational cohort study

Correction to: Extending the straight leg raise test for improved clinical evaluation of sciatica: validity and diagnostic performance with reference to the magnetic resonance imaging

Dynamic Tendon Grip (DTG™) novel knot array compared to traditional sutures for zone two flexor tendon injury – a biomechanical feasibility study

Interobserver reliability of scapula fracture classifications in intra- and extra-articular injury patterns