Value of Thrombin-Antithrombin III Complexes in Major Orthopedic Surgery: Relation to the Onset of Venous Thromboembolism

Abstract

This study evaluated (a) the possible changes of plasma levels of thrombin-antithrombin III complexes during hospitalization to predict venous thromboembolism in patients undergoing elective total hip replacement and (b) the sensitivity and specificity of thrombin-antithrombin III complexes in the late incidence of deep vein thrombosis when these patients are discharged from the hospital. In 50 consecutive patients (18 men, mean age = 63 +/- 8 years) a venous blood sample was obtained from each patient before surgery and postsurgery on days 5 +/- 2, 9 +/- 2, and 45 to evaluate the thrombin-antithrombin III complexes by the enzyme-linked immunosorbent assay as a part of a larger surveillance program. Six of 50 patients developed deep vein thrombosis, diagnosed by phlebography on the 45th day postsurgery. From the day before until the ninth day after surgery, mean values of the thrombin-antithrombin III complexes increased to a greater extent in patients with deep vein thrombosis than in those without, although the differences were not significant (from 14.8 +/- 11.2 ng/mL to 36.2 +/- 19.1 ng/mL in the former group and from 13.6 +/- 3.3 ng/mL to 22.4 +/- 5.1 ng/mL in the latter, p = NS). On the 45th day after surgery the mean value of the thrombin-antithrombin III complexes reduced less in patients with deep vein thrombosis (up to 9.9 +/- 1.9 ng/mL and to 25.2 +/- 17.2 ng/mL, respectively, p = NS). In addition, thrombin-antithrombin III complexes remained over the level reached on the fifth day only in the patients who developed deep vein thrombosis. On the 45th day after surgery, thrombin-antithrombin III complexes exhibited a sensitivity of 17%, a specificity of 86%, and an accuracy of 78% in differentiating the presence and absence of deep vein thrombosis as compared with phlebography. We conclude that after total hip replacement (a) serial measurement of the thrombin-antithrombin III complexes does not appear helpful in predicting venous thromboembolism during hospitalization, and (b) measurement of thrombin-antithrombin III complexes has a low diagnostic accuracy in diagnosing delayed deep vein thrombosis. However, the greater and persistent increase of thrombin-antithrombin III complexes level in patients who developed deep vein thrombosis may deserve further investigations.

Enteral immuno-enhanced diets with arginine are safe and beneficial for patients early after esophageal cancer surgery

“…However, no patients in this study were required to undergo repeat surgery due to surgical site bleeding, and no significant difference in the daily volume of drainage fluid was observed between the two groups (data not shown). Early postoperative activation of coagulation is associated with perioperative myocardial cell damage in patients undergoing vascular surgery 26 and deep vein thrombosis in patients undergoing elective total hip replacement 27 or surgery for colorectal 28 or maxillofacial malignancies 29 . With respect to postoperative complications, the hypocoagulant effects of the IED formula are considered to be beneficial to patients following esophageal surgery.…”

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

“…However, TAT formation represents only an indirect measurement of an activated coagulation system [16], and is frequently influenced by peripheral blood sampling techniques under venous occlusion. Thus, measurement of TAT has a low diagnostic accuracy for thrombotic events [17], though marked and persistent TAT level increases may deserve further investigation.…”

Recommendations from the ICM-VTE: General

“…Numerous serological markers have been studied for diagnosing VTE. We identified 50 such markers 940-989 , out of these Plasminogen activator inhibitor-1 (PAI-1), soluble fibrin (SF), fibrinogen degradation product (FDP), Thrombin antithrombin-III (TAT) complexes, Prothrombin fragment 1 + 2 (PF) 1 + 2 and fibrinogen have been frequently used in patients with orthopaedic conditions. These serological markers can be classified according to the pathophysiology of DVT or thrombotic disease, one is coagulation markers, such as D-dimer, Factor VIII, thrombin generation (TG), and fibrin monomer (FM), while the other is inflammatory markers, including P-selectin, inflammatory cytokines, microparticles (MP) and leukocyte count 990 .…”