Wang Han, Liu Jiacheng, Lai Xiaofei, Li Xinyu, Huang Wei
Department of Orthopedics, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou 363000, China.
Department of Orthopedics, The First Affiliated Hospital of Chongqing Medical University, Orthopedic Laboratory of Chongqing Medical University, Chongqing 400016, China.
J Clin Med. 2023 Feb 1;12(3):1161. doi: 10.3390/jcm12031161.
This study aims to evaluate the efficacy of anti-factor Xa activity (aFXa) in predicting ecchymosis after total knee arthroplasty (TKA). One hundred and two unilateral primary TKA patients were recruited consecutively in this prospective observational study. Participants received rivaroxaban (10 mg p.o. qd) from postoperative day 1 (POD1) to POD35 and were divided into a non-ecchymosis group (group A) and an ecchymosis group (group B). AFXa was assessed as the primary outcome on POD1 and POD3. Prothrombin time (PT), activated partial thromboplastin time (APTT) and thromboelastography (TEG) were recorded both preoperatively and postoperatively (on POD1 and POD3). Other outcomes, including venous thromboembolism (VTE), blood loss and wound complications were also collected and compared. As a result, 27.5% of the participants (n = 28) were allocated into group B. Demographic data were comparable between the two groups. The aFXa levels in group B were significantly higher than those in group A on POD1 and POD3, and the aFXa level was assessed as an independent risk factor for ecchymosis. The cut-off value of aFXa was determined to be 121.38 ng/mL at maximal Youden index, associated with area under the receiver operating characteristics curve of 0.67. Group B experienced significantly more blood loss and wound complications than group A. No statistical difference was detected regarding PT, APTT and TEG parameters. AFXa is a promising parameter to predict ecchymosis after TKA. Patients with aFXa > 121.38 ng/mL should be considered as high-risk population for postoperative ecchymosis and may require intense monitoring or dosage modification of anticoagulants.
本研究旨在评估抗Xa因子活性（aFXa）在预测全膝关节置换术（TKA）后瘀斑方面的疗效。在这项前瞻性观察研究中，连续招募了102例单侧初次TKA患者。参与者从术后第1天（POD1）至POD35接受利伐沙班（口服10 mg，每日1次），并被分为无瘀斑组（A组）和瘀斑组（B组）。在POD1和POD3将aFXa作为主要结局进行评估。术前和术后（POD1和POD3）记录凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）和血栓弹力图（TEG）。还收集并比较了其他结局，包括静脉血栓栓塞（VTE）、失血和伤口并发症。结果，27.5%的参与者（n = 28）被分配到B组。两组之间的人口统计学数据具有可比性。B组在POD1和POD3时的aFXa水平显著高于A组，且aFXa水平被评估为瘀斑的独立危险因素。在最大约登指数时，aFXa的截断值确定为121.38 ng/mL，受试者工作特征曲线下面积为0.67。B组的失血量和伤口并发症明显多于A组。在PT、APTT和TEG参数方面未检测到统计学差异。aFXa是预测TKA后瘀斑的一个有前景的参数。aFXa>121.38 ng/mL的患者应被视为术后瘀斑的高危人群，可能需要加强监测或调整抗凝剂剂量。
