Division of Sports Medicine and Adult Reconstructive Surgery, Department of Orthopedic Surgery, Nanjing Drum Tower Hospital, Affiliated Hospital of Medical School, Nanjing University, 321 Zhongshan Road, Nanjing, 210008, Jiangsu, PR China.
Department of Orthopedics, The Second Affiliated Hospital of XuZhou Medical University, Xuzhou, Jiangsu, 221006, PR China.
J Orthop Surg Res. 2024 Oct 1;19(1):616. doi: 10.1186/s13018-024-05074-3.
Caprini score and D-dimer are well-recognized markers in deep vein thrombosis (DVT) assessment. However, their utility in guiding post-arthroplasty DVT risk is hampered by susceptibility to various post-operative factors, limiting their effectiveness as reminders. Conversely, these markers exhibit greater stability in the pre-operative setting. Despite this, research on the pre-operative predictive value of Caprini score and D-dimer for DVT following primary total knee arthroplasty (TKA) remains scarce.
In a retrospective study, we analyzed data from patients who underwent primary TKA, between August 2015 and December 2022. Upon admission, Caprini scores were assessed, and comprehensive blood panels were obtained from fasting blood samples. For all patients, lower limb vascular Doppler ultrasonography was performed pre-operatively to exclude those with pre-existing DVT, and all patients underwent DVT examination again post-operatively.
Our study included 2,873 patients, averaging 67.98 ± 7.54years, including 676 men and 2,197 women. In this study, 303 (10.55%) patients developed postoperative DVT, and 57 (1.98%) cases presented with lower limb symptoms. DVT incidence in patients with pre-operative Caprini scores of 1-2 (6.50%), 3 (10.28%), and ≥ 4 (18.05%) showed significant differences (P < 0.05). DVT rates were 14.80% in patients with pre-operative D-dimer levels of ≥ 1 mg/L, higher than the 8.98% in those with levels of < 0.5 mg/L, and 10.61% in those with levels 0.5-1 mg/L (P < 0.05). In patients with Caprini scores of 1-2 and D-dimer levels ≤ 0.5 mg/L, the occurrence rate of postoperative DVT was only 5.84%. For patients with Caprini scores ≥ 4 and D-dimer levels ≥ 1.0 mg/L, the postoperative DVT occurrence rate soared to 24.81%, with the OR(odds ratio) was 4.744 compared to the former group.
Patients with preoperative higher Caprini scores and D-dimer are more likely to develop DVT after TKA. Additionally, those with a preoperative Caprini score ≥ 4 and D-dimer level ≥ 1.0 mg/L have a significantly increased risk (24.81%) of developing DVT, identifying them as a high-risk group for DVT following TKA. These findings hold significant value for DVT risk stratification in primary TKA patients and the formulation of preoperative interventions to mitigate the risk of DVT.
卡普里尼评分和 D-二聚体是深静脉血栓形成（DVT）评估中公认的标志物。然而，由于易受各种术后因素的影响，它们在指导关节置换术后 DVT 风险方面的效用受到限制，限制了它们作为提醒的有效性。相反，这些标志物在术前表现出更大的稳定性。尽管如此，关于卡普里尼评分和 D-二聚体在初次全膝关节置换术（TKA）后 DVT 中的术前预测价值的研究仍然很少。
在一项回顾性研究中，我们分析了 2015 年 8 月至 2022 年 12 月期间接受初次 TKA 的患者的数据。入院时评估卡普里尼评分，并从空腹血样中获得全面的血液检查结果。所有患者在术前均进行下肢血管多普勒超声检查以排除预先存在的 DVT，所有患者术后均再次进行 DVT 检查。
本研究共纳入 2873 例患者，平均年龄为 67.98±7.54 岁，其中男性 676 例，女性 2197 例。在这项研究中，303 例（10.55%）患者发生术后 DVT，57 例（1.98%）患者出现下肢症状。术前卡普里尼评分为 1-2（6.50%）、3（10.28%）和≥4（18.05%）的患者术后 DVT 发生率存在显著差异（P<0.05）。术前 D-二聚体水平≥1mg/L 的患者 DVT 发生率为 14.80%，高于<0.5mg/L 的 8.98%和 0.5-1mg/L 的 10.61%（P<0.05）。卡普里尼评分为 1-2 分且 D-二聚体水平≤0.5mg/L 的患者术后 DVT 发生率仅为 5.84%。卡普里尼评分≥4 分且 D-二聚体水平≥1.0mg/L 的患者术后 DVT 发生率高达 24.81%，与前一组相比，OR（比值比）为 4.744。
术前卡普里尼评分和 D-二聚体较高的患者在 TKA 后更容易发生 DVT。此外，术前卡普里尼评分≥4 分且 D-二聚体水平≥1.0mg/L 的患者发生 DVT 的风险显著增加（24.81%），提示其为 TKA 后 DVT 的高危人群。这些发现对于 TKA 患者的 DVT 风险分层和制定术前干预措施以降低 DVT 风险具有重要意义。
