2023, Vol. 27 ›› Issue (4): 572-577

Early warning efficacy of thrombus molecular markers after total knee arthroplasty in patients complicated with venous thromboembolism

Zhang Jinbiao1, Li Xiaoming2, Xing Wanlin1, Ma Fei1, Yu Qiaoya1, Dai Rongqin3   

Abstract: BACKGROUND: Complications such as infection, arrhythmia, pulmonary embolism, heart failure, and deep vein thrombosis exist after total knee arthroplasty, and venous thromboembolism is an important risk factor for surgical failure. Therefore, effective postoperative thrombosis monitoring is particularly important.
OBJECTIVE: To discuss the early warning value of thrombus molecular markers in the patients after total knee arthroplasty complicated with venous thromboembolism.
METHODS: A retrospective analysis of the data of 80 patients, who received total knee arthroplasty in Hebei Hospital of Integrated Traditional Chinese and Western Medicine between April and July 2021, was performed. The patients were divided into thrombus group (n=39) and non-thrombus group (n=41) based on thrombus formation 3 days after operation. Totally 40 people who had a health checkup during the same period were chosen as the control group. Thrombus molecular markers were tested in each group: thrombin-antithrombin complex, plasmin-antiplasmin complex, thrombomodulin, and tissue plasminogen activator inhibitory complex. The markers were examined in total knee arthroplasty patients on the day before surgery and 8 hours after surgery. The markers were tested once in the control group.
RESULTS AND CONCLUSION: (1) One day before surgery: thrombin-antithrombin complex and plasmin-antiplasmin complex levels in the non-thrombus group were higher than those in the control group (P < 0.05). Thrombin-antithrombin complex and thrombomodulin levels in the thrombus group were higher than those in the non-thrombus group (P < 0.05). The thrombus molecular marker levels of the thrombus group were higher than those in the control group (P < 0.05). (2) At 8 hours postoperatively, the thrombus molecular marker levels of the thrombus group were higher than those in the non-thrombus group (P < 0.05). (3) Logistics regression analysis showed that the single index thrombomodulin had the best prediction efficiency (ACU=0.814, sensitivity 76.70%, specificity 83.80%, P=0.000). Combined detection of thrombin-antithrombin complex and thrombomodulin could improve prediction efficiency (ACU=0.822, sensitivity 83.30%, specificity 76.80%, P=0.000). The single index thrombin-antithrombin complex had the best prediction efficiency (ACU=0.898, sensitivity 83.30%, specificity 84.80%, P=0.000). Combined detection of thrombin-antithrombin complex and plasmin-antiplasmin complex could improve prediction efficiency (ACU=0.897, sensitivity 88.30%, P=0.000). (4) Spearman’s linear correlation analysis showed that tissue plasminogen activator inhibitory complex and plasmin-antiplasmin complex had a good positive correlation (r2=0.209, P < 0.05). (5) It is concluded that thrombomodulin can be used as an early warning indicator before total knee arthroplasty. Thrombin-antithrombin complex is a specific indicator of venous thromboembolism occurrence. Combined detection of thrombin-antithrombin complex, plasmin-antiplasmin complex, thrombomodulin, and tissue plasminogen activator inhibitory complex can improve prediction efficiency for venous thromboembolism.  
Key words: thrombus molecular marker, total knee arthroplasty, venous thromboembolism, early warning efficiency, specificity, sensitivity, cutoff value, guide