Coagulation and Fibrinolysis Markers and Their Use for the Prediction of High Risk Patients with Venous Thromboembolism Following Total Hip Arthroplasty

Inaba, Yutaka; Yukizawa, Yohei; Saito, T.

doi:10.5772/57248

Cited by 3 publications

(9 citation statements)

References 42 publications

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“…Considering that TAT levels can reflect the levels of thrombin formation, the increased levels of TAT indicate the activation of the coagulation system and contribute to the risk of VTE. 18,22,23 Yukizawa et al demonstrate that the levels of TAT in patients with VTE are higher than those without VTE after joint arthroplasty, which are consistent with our findings. 6 d -Dimer is formed as a result of plasmin digestion of cross-linked fibrin and therefore only occurs when both clotting and fibrinolytic systems are activated.…”

Section: Discussionsupporting

confidence: 93%

“…During the early stage of VTE, the disturbances in coagulation and fibrinolysis occur before the activation of thrombosis. 1,9,[17][18][19] Hence, the coagulation indices may become abnormal prior to imagological examination. Moreover, joint arthroplasty can lead to an unbalance between coagulation and fibrinolysis.…”

Section: Discussionmentioning

confidence: 99%

“…3,14,15 Joint arthroplasty can lead to an unbalance between coagulation and fibrinolysis, 6,16 and the disturbances in coagulation and fibrinolysis occur before the formation of emboli. 1,9,17–19 Hence, the coagulation and fibrinolysis indices may become abnormal prior to imagological examination. Therefore, it is necessary to identify accurate biomarkers that reflect the changes in coagulation and fibrinolysis in order to predict the occurrence of postoperative VTE, especially symptomatic and fatal pulmonary embolism.…”

Section: Introductionmentioning

confidence: 99%

“…18,20 Thrombin-antithrombin (TAT) is a complex that reflects the formation of thrombin, 18,[21][22][23] while plasmin-a2-antiplasmin complex (PIC) is a fibrinolytic marker that directly reflects the generation of plasmin. 16,18,24 In addition, both soluble thrombomodulin (sTM) and tissue plasminogen activator inhibitor complex (t-PAIC) are the markers involved in the endothelial system. 23,25 Previous studies have reported that high levels of D-dimer and TAT are correlated with postoperative VTE.…”

Section: Introductionmentioning

confidence: 99%

“…23,25 Previous studies have reported that high levels of D-dimer and TAT are correlated with postoperative VTE. 1,9,[17][18][19]26 Besides, TM can combine with thrombin to activate protein C and thus prevent coagulation. 2,[27][28][29][30] Research studies have demonstrated that level of sTM increases after joint arthroplasty, 23,24 and Kearon et al found that recombinant human sTM is an effective agent to prevent thrombosis after orthopedic surgery.…”

Section: Introductionmentioning

confidence: 99%

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Clinical Impact of Coagulation and Fibrinolysis Markers for Predicting Postoperative Venous Thromboembolism in Total Joint Arthroplasty Patients

Cheng

Liu

et al. 2019

Clin Appl Thromb Hemost

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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 P < .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 ( P < .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.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Clinical Impact of Coagulation and Fibrinolysis Markers for Predicting Postoperative Venous Thromboembolism in Total Joint Arthroplasty Patients

Cheng

Liu

et al. 2019

Clin Appl Thromb Hemost

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Benefits of Tranexamic Acid in Total Knee Arthroplasty: A Classification and Regression Tree Analysis in Function of Instrumentation, BMI, and Gender

et al. 2021

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Tranexamic acid (TXA) is an antifibrinolytic drug that reduces blood loss in patients that undergo Total knee arthroplasty (TKA). Few studies compare its effect on conventional instrumentation (CI) versus patient-specific instrumentation (PSI). The main objective of this study was to understand analytically how TXA usage in both instrumentations influenced blood loss in TKA differently and see if the differences seen could be explained by the patient's body mass index (BMI) and gender. This nonrandomized retrospective study sample consisted of 688 TKA procedures performed on patients who had symptomatic arthrosis resistant to conservative treatment. Descriptive analysis was used to evaluate blood loss using hemoglobin (Hb) mean values and mean variation (%). The Classification and Regression Tree (CRT) method was applied to understand how the independent variables affected the dependent variable. Comparing patients submitted to the same instrumentation, where some received TXA and others did not, patients that received TXA had lower blood loss. Comparing patients who underwent TKA with different instrumentations and without the use of TXA, it was found that patients who underwent TKA with PSI had lower blood loss than those who underwent TKA with CI. However, when these same instruments were compared again, but associated with the use of TXA, the opposite was true with patients undergoing TKA with PSI showing greater blood loss than patients undergoing TKA with CI. TXA usage in TKA is significantly beneficial in minimizing blood loss and regardless of instrumentation. When using TXA, the lowest blood loss was obtained in patients with higher BMI and submitted to TKA with CI. This is most likely explained by the synergistic antifibrotic effect of TXA with adipokines, such as plasminogen activator inhibitor-1 (PAI-1), found in the femoral bone marrow which is perforated using CI. If, however, TXA wasn't used, the lowest blood loss was obtained in patients submitted to TKA with PSI.

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Functional evolution in total knee arthroplasty: first and second-generation patient-specific instrumentation compared with conventional instrumentation

et al. 2023

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Background: This study compares the functional evolution between the first- and second-generation patient-specific instrumentation and conventional instrumentation pre-surgery and the third month post-surgery after TKA. We analyzed the functional outcomes achieved and the absolute gains of each study variable. In addition, we aimed to elucidate the results of the three surgical techniques regarding the surgery length of time, length of hospital stay, percentage drop in hemoglobin (Hg) at 24 h, and hip-knee-ankle angle post-surgery. Methods: We reported our experience in TKA using PSI Visionaire System® and CI technique in 688 procedures. The patients were divided into first (N=272) and second-generation (N=151) PSI designs. The control group (N=265) underwent TKA with the CI. The instruments for assessing the functioning were: visual analog scale, goniometry, 6-minute walk test (6MWT), and domains of the WOMAC Index. Results: The functioning achieved three months after surgery was lower in the CI than the first-generation PSI. The respective differences at absolute gains were found in the 6MWT and pain and function WOMAC scores (p=0.023, p=0.049, and p=0.018, respectively). The mean surgical time was higher in the CI compared to PSI designs (both p<0.001), and the mean hospital length of stay was higher in the CI compared to second-generation PSI (p=0.002). The percentual drop in Hg was higher in the first-generation PSI than with the CI (p=0.006). Conclusions: Three months after TKA, the functioning achieved with the first-generation PSI was greater than the CI. However, the functional results between second-generation PSI and CI were similar.

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Coagulation and Fibrinolysis Markers and Their Use for the Prediction of High Risk Patients with Venous Thromboembolism Following Total Hip Arthroplasty

Cited by 3 publications

References 42 publications

Clinical Impact of Coagulation and Fibrinolysis Markers for Predicting Postoperative Venous Thromboembolism in Total Joint Arthroplasty Patients

Clinical Impact of Coagulation and Fibrinolysis Markers for Predicting Postoperative Venous Thromboembolism in Total Joint Arthroplasty Patients

Benefits of Tranexamic Acid in Total Knee Arthroplasty: A Classification and Regression Tree Analysis in Function of Instrumentation, BMI, and Gender

Functional evolution in total knee arthroplasty: first and second-generation patient-specific instrumentation compared with conventional instrumentation

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