Blood coagulation biomarkers for postoperative venous thromboembolism diagnosis in orthopedic traumatic patients: a case control study

Abstract

Objective To evaluate the value of blood coagulation biomarkers in orthopaedic traumatic patients after surgery and analyze its diagnostic values for venous thrombosis embolism. Methods In thiscase control study, we consecutive enrolled 108 traumatic patients after surgery. 54 patients have thrombosis and other 54 patients have no thrombosis. Blood was taken 3-4 days after surgery. Routine coagulation screening test , FDP(fibrinogen/fibrin degradation products) , D dimer and new item such as TM(thrombomodulin), TAT(thrombin-anti-thrombin complex), t-PAIC(tissue- type plasminogen activator-plasminogen activator inhibitor complex), PIC(plasmin-anti-plasmin complex) were tested. The difference between groups of these biomarkers was compared, and then the receiver operation curve (ROC) was drew to determine the diagnostic cut-off point and diagnostic performance. Results ALL blood coagulation biomarkers in orthopaedic traumatic patients after surgery were significantly increased. The group of patients with thrombosis have higher TM(9.04±2.06)IU/ml, t-PAIC(10.15±4.23)ng/ml, PIC(1.15±0.70)μg/ml, D dimer(5.31±5.10)ng/ml than group without thrombosis TM(7.50±1.70)IU/ml, t-PAIC (6.97±2.56)ng/ml, PIC(0.93±0.84)μg/ml, D dimer(2.35±2.12)ng/ml, and P=0.000 2, <0.000 1, <0.000 1, <0.000 1, respectively. However, TAT(4.79±4.32)ng/ml, (6.51±5.92)ng/ml, FDP(8.87±7.68)μg/ml, (4.91±4.67)μg/ml showed no difference between thrombosis groupand no thrombosis group, (P=0.212 3, 0.050 8; respectively). The area under the ROC curve of TM, t-PAIC, PIC and D-dimer were 0.718 5, 0.741 6, 0.648 0, 0.670 0, respectively; P values were <0.000 1, <0.000 1, 0.009 3, 0.004 1, respectively; cut-off values were 11.15 IU/ml, 10.65 ng/ml, 1.36 μg/ml, 7.69 ng/ml, respectively; positive likelihood ratios were 9.00, 11.29, 3.66, 14.60, respectively; specificity were 98.15%, 96.23%, 90.20%, 97.96%, respectively; the diagnostic rates were 20.3%, 46.3%, 35.8%, 25.9%, respectively. Conclusions There were coagulation and fibrinolysis system activated in orthopaedic traumatic patients after surgery.TM, t-PAIC, PIC, D dimer were good biomarkers for the diagnosis of thrombosis after trauma surgery. TAT was not fit for screening thrombosis after surgery because of influence of anti-coagulation.(Chin J Lab Med, 2016, 39: 751-755) Key words: Postoperative complications; Venous thrombosis; Biological markers; Thrombomodulin; Tissue plasminogen activator; Fibrin fibrinogen degradation products