The diagnostic value of thromboelastography and D-dimer on anticoagulation therapy concurrenting DVT in the perioperative period of arthroplasty replacement

Abstract

Objective To investigate the predictive value and clinical significance of dynamic monitoring of thromboelastography (TEG) and D-dimer on anticoagulation therapy concurrenting DVT in the perioperative period of arthroplasty replacement. Methods All of 60 patients of total knee arthroplasty (TKA) were selected as patient group from 2011 to 2013. They were divided into low molecular weight heparin (LMWH) group and rivaroxaban group according to random number table. LMWH group was given LMWH (xi fu quan) 4250 IUAXa 12 h after knee replacement, im, qd for 7 days, then rivaroxaban 10 mg, qd for 7 days. Rivaroxaban group was given rivaroxaban 10 mg 6 h after knee replacement, qd for 14 days. Meanwhile, 42 health examination participants were selected as control group. The parameters of TEG were detected by TEG 5000 thromboelastograph hemostasis system (American Haemoscope Corporation). Results D-dimer levels of postoperative before anticoagulation therapy were highest and there was statistical difference, while other parameters had no statistical difference. Intra-group comparison: the levels of R, K, Alpha, CI of TEG and D-D in LMWH group and the levels of Alpha, MA, CI of TEG and D-D in rivaroxaban group had statistical difference, while other parameters' levels showed no statistical difference. At anticoagulation treatment endpoint, DVT occurred in 8 cases with an incidence of 13.3% (8/60). 7 cases were intramuscular vein thrombosis, and 1 case was popliteal vein thrombosis. The levels of Alpha, MA, CI of TEG and D-D in DVT group were higher than no DVT group, and there was statistical difference. TEG's CI, MA, Alpha and D-dimer had better clinical diagnostic value on DVT, whose area under receiver operating characteristic cure (ROC) respectively was 0.746, 0.733, 0.707 and 0.644, with sensitivity of 75%, 75%, 62.5% and 62.5%, specificity of 80.8%, 76.9%, 78.8% and 71.1%, positive predictive value of 37.5%, 33.3%, 31.3% and 25.0%, and negative predictive value of 95.4%, 95.2%, 93.2% and 93.1%. MA=68.35 mm was the best clinical diagnosis of critical point on DVT at anticoagulation treatment endpoint. Conclusion CI, MA, Alpha of TEG are better than D-dimer in predicting the incidence of DVT in the perioperative period of orthopaedics major operation. If these indexes are detected, the diagnosis value's accuracy of DVT will be improved. Key words: Arthroplasty, replacement, knee; Venous thrombosis; Thrombelastography; ROC curve