Department of laboratory medicine, Peking University Fourth School of Clinical Medicine, Beijing, China.
Adult reconstruction department, Beijing Jishuitan Hospital, Beijing, China.
Clin Appl Thromb Hemost. 2019 Jan-Dec;25:1076029619877458. doi: 10.1177/1076029619877458.
One common complication after joint arthroplasty is venous thromboembolism (VTE). Therefore, it is essential to measure the changes in coagulation and fibrinolysis in order to predict VTE among patients who underwent joint arthroplasty. This study aimed to identify potential useful biomarkers for prognosing to VTE. This was a prospective cohort study enrolling 83 patients who underwent joint arthroplasty. The levels of d-dimer, thrombin-antithrombin complex (TAT), plasmin-α2-antiplasmin complex (PIC), soluble thrombomodulin, and tissue plasminogen activator inhibitor complex were measured on day 0 (before surgery) and days 1, 3, and 6 after surgery. Ultrasound examination was used to diagnose VTE on preoperative day 0 and postoperative day 6. A total of 35 patients developed VTE after surgery. Patients with VTE exhibited significantly higher levels of d-dimer and TAT on postoperative days 3 and 6 (all < .05). The area under curves (AUC) of receiver operating characteristic (ROC) were 0.65 and 0.68 and 0.68 and 0.74 for d-dimer and TAT levels on postoperative days 3 and 6, respectively. The level of TAT/PIC ratio on postoperative day 6 was significantly increased among patients with VTE compared to non-VTE patients ( < .0001). In addition, the AUC of ROC, cutoff level, sensitivity, specificity, positive-predictive value, and negative-predictive value of TAT/PIC ratio were 0.78, 4.03 ng/TU, 97.14%, 33.33%, 51.52%, and 94.12%, respectively. The high sensitivity and negative predictive value of TAT/PIC ratio make it a potential prognostic index for diagnosing VTE during the early phase of postoperative joint arthroplasty.
关节置换术后的一个常见并发症是静脉血栓栓塞症（VTE）。因此，测量凝血和纤溶的变化对于预测关节置换术后患者的 VTE 至关重要。本研究旨在确定潜在有用的生物标志物来预测 VTE。这是一项前瞻性队列研究，共纳入 83 例接受关节置换术的患者。在术前 0 天（手术前）和术后第 1、3 和 6 天测量了 D-二聚体、凝血酶抗凝血酶复合物（TAT）、纤溶酶-α2-抗纤溶酶复合物（PIC）、可溶性血栓调节蛋白和组织型纤溶酶原激活物抑制剂复合物的水平。超声检查用于诊断术前 0 天和术后第 6 天的 VTE。共有 35 例患者术后发生 VTE。术后第 3 和第 6 天，发生 VTE 的患者 D-二聚体和 TAT 水平明显升高（均<0.05）。D-二聚体和 TAT 水平术后第 3 天和第 6 天的 ROC 曲线下面积（AUC）分别为 0.65 和 0.68，0.68 和 0.74。与非 VTE 患者相比，VTE 患者术后第 6 天的 TAT/PIC 比值明显升高（<0.0001）。此外，TAT/PIC 比值的 ROC 曲线 AUC、截断值、灵敏度、特异性、阳性预测值和阴性预测值分别为 0.78、4.03ng/TU、97.14%、33.33%、51.52%和 94.12%。TAT/PIC 比值具有较高的灵敏度和阴性预测值，使其成为预测术后早期关节置换术后 VTE 的潜在预后指标。
