DOI: 10.1097/md.0000000000050228 ISSN: 0025-7974

Thrombus molecular markers and thromboelastogram as early predictors of venous thromboembolism after total knee arthroplasty in perioperative elderly patients

Bei Zhang, Huan Zhao, Jie Lu, Song Zhang, Li Chang
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Elderly patients undergoing total knee arthroplasty have a higher incidence of venous thromboembolism (VTE) owing to age, surgical trauma, and other factors. Numerous studies have employed the Caprini scale and

d
-dimer levels to evaluate perioperative coagulation function and predict the occurrence of postoperative VTE. However, relatively few studies have assessed the risk of VTE by analyzing perioperative thrombus molecular markers and thromboelastography (TEG) findings in these patients. This prospective cohort study enrolled patients aged >60 years who underwent artificial knee replacement surgery between March 2024 and September 2024 at the Department of Arthroplasty of the Third Hospital of Hebei Medical University. The levels of thrombus molecular markers, including thrombin–antithrombin complex (TAT), plasmin-α 2 -plasmininhibitor complex, thrombomodulin, tissue plasminogen activator–inhibitor complex, and TEG, which included reaction time (R), clot kinetics (K), angle α, maximum amplitude, and clotting index (CI), were measured preoperatively and at postoperative hours 2 (poh2), day 1 (pod1), and day 3 (pod3). The patients were categorized into VTE and non-VTE groups based on color Doppler ultrasonography screening on postoperative day 4. We examined the disparities in general information indicators between the 2 groups, and logistic regression was used to analyze deep vein thrombosis risk factors in these patients. The diagnostic effectiveness of markers was determined using the receiver operating characteristic curve. TAT and TEG partial parameters are capable of reflecting the postoperative hypercoagulable state of the body with sensitivity; the combination of these parameters is anticipated to offer a strong predictive value in elderly patients. The median age in the VTE group was 71 (60–82), higher than 66 (60–83) in the non‑VTE group, and significant differences were found between the 2 groups ( P  = .025). Significant differences in R ( P  = .007), angle α ( P  = .029), and TAT ( P  = .047) on pod1 and clotting index ( P  = .027), TAT ( P  = .017), and TAT/plasmin inhibitor complex ( P  = .004) on pod3 were observed between the 2 groups. Binary logistic regression revealed that age, R value, angle α, TAT, and age were significant risk factors for deep vein thrombosis. Our research indicates that the area under the curve, sensitivity, and specificity of multi-index detection are superior to single-index detection.

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