Application Of The Combination Of Thromboelastography And Routine Coagulation Tests In The Diagnosis For Deep Vein Thrombosis In Arthroplasty

Background and objectiveThromboelastography(TEG)is an analyzer that can monitor the whole process of coagulation.Compared with routine coagulation tests,TEG can record the dynamic changes of coagulation and comprehensively reflect the coagulation and fibrinolysis capability of whole blood.TEG has been applied widely in cardiac surgery,liver transplantation and severe trauma to assess the body’s coagulation status and guide hemostasis and blood transfusion.However,it has not ben broadly used in orthopedic surgery,and its value in the diagnosis of deep vein thrombosis(DVT)in arthroplasy is still inconclusive.The objective of this study was to explore the appliction value of TEG in the perioperative period of total hip arthroplasty(THA)and total knee arthroplasty(TKA)and the diagnostic value of TEG for postoperative deep vein thrombosis.MethodsPatients admitted to orthopedics of our hospital to undergo THA or TKA were recruited from August 2021 to January 2022.The general information of the patients was collected.TEG,routine blood test(hemoglobin concentration,hematocrit,platelet count,platelet volume),routine coagulation tests(prothrombin time,activated partial thromboplastin time,fibrinogen content,D-dimer)and lower limb Doppler ultrasonography were performed before surgery and on the first or third day after surgery.The t-test,non-parametric test,and chi-square test were used to compare the differences between patients with deep vein thrombosis and those without.Pearson and Spearman rank-order correlation was used to describe the the relationship of the parameters of TEG and routine coagulation tests.ROC was applied to evaluate the monitoring value of thromboelastography parameters,routine coagulation tests and other indicators for deep vein thrombosis.The Youdan index was used to determine the corresponding cut-off value for each parameter.ResultsThe incidence of patients developing deep vein thrombosis on the first day after TKA is 27.66%,while that on the first day after THA is 6.67%.Regarding the change of perioperative test indicators,TEG parameters with significant differences between preoperative and postoperative day 1 included reaction time(R value),coagulation index(CI),and blood clot mechanical intensity named G value.Among routine coagulation function indicators,D-dimer dad statistical change after surgery.Regarding the difference in test indicators between patients with and without thrombosis on the first day after surgery,preoperative D-dimer,postoperative R value and postoperative activated partial thromboplastin time(APTT)had statistical difference.According to ROC analysis,4.35min was the best diagnostic point of R value(95%CI 0.668-0.964,P=0.005)on DVT on postoperative day 1,with the sensitivity of 0.900 and the specificity of 0.636.While the best truncation value of APTT(95%CI 0.638-1.000,P=0.028)on postoperative day 1 was 24.7s,with the sensitivity of 0.800,and the specificity of 0.875.The best diagnostic point of CI(95%CI 0.564-0.895,P=0.029)on DVT on postoperative day 1,with the sensitivity of 0.700 and the specificity of 0.794.The combination of R value and CI(95%CI 0.712-0.959,P=0.001)had a diagnostic sensitivity of 0.900 and a specificity of 0.765.ConclusionsThe parameters of TEG have different changes in different clinical situations of joint replacement.In patients without anticoagulation after TKA on the same day,more parameters of TEG are correlated with routine coagulation tests with greater application value.Compared with routine coagulation tests,TEG is more sensitive to review hyper-coagulable state of the body after surgery.And the combination of R value and CI has better diagnostic value for the formation of DVT on the first day after arthroplasty.