Subscribe to RSS
DOI: 10.1055/s-0038-1647115
Thrombin-Antithrombin III Complexes in the Prediction of Deep Vein Thrombosis Following Total Hip Replacement
Publication History
Received 02 March 1989
Accepted after revision 12 September 1989
Publication Date:
24 July 2018 (online)
![](https://www.thieme-connect.de/media/10.1055-s-00035024/198904/lookinside/thumbnails/10-1055-s-0038-1647115-1.jpg)
Summary
In 196 consecutive patients who underwent elective total hip surgery we investigated the diagnostic accuracy of the thrombinantithrombin III complex immunoassay, as assessed on the first, fourth and tenth postoperative day, for the development of deep vein thrombosis (DVT). Patients received either LMWheparinoid (n = 97) or placebo (n = 99) and underwent contrast venography on the tenth postoperative day.
Thrombin-antithrombin III (T-AT) plasma levels were raised in all patients on the first postoperative day and gradually decreased during the study period. T-AT plasma levels were significantly higher in patients developing DVT when compared to patients without DVT and remained so until day 10. This difference was apparent both in the LMW-heparinoid group as well as in the placebo-treated patients.
ROC-curve analysis revealed no satisfactory discriminative power for the diagnosis of developing DVT at any of the studied cut-off values for T-AT.
We conclude that the postoperative determination of T-AT complex plasma concentrations in hip surgery patients has no clinical utility in the prediction of postoperative DVT.
-
References
- 1 Bauer KA, Rosenberg RD. The pathophysiology of the Prethrombotic state in humans: Insight gained from studies using markers of hemostatic system activation. Blood 1987; 70: 343-350
- 2 Collen D, De Cock F, Verstraete M. Quantitation of thrombinantithrombin III complexes in human blood. Eur J Clin Invest 1977; 7: 407-411
- 3 Teitel JM, Bauer KA, Lau HK, Rosenberg RD. Studies of the prothrombin activation pathway utilizing radio-immuno-assays for the F2/Fl + 2 fragment and thrombin-antithrombin complex. Blood 1982; 59: 1086-1097
- 4 Hoek JA, Sturk A, ten Cate JW, Lamping RJ, Berends F, Borm JJ J. Laboratory and clinical evaluation of an assay of thrombinantithrombin. III complexes in plasma. Clin Chem 1988; 34 (10) 2058-2062
- 5 Rogers PH, Walsh PN, Marder VJ, Bozak GC. et al Controlled trial of low dose heparin and sulphinpyrazone to prevent venous thromboembolism after operation on the hip. J Bone Joint Surg 1978; 60 A 758-762
- 6 Sautter RD, Koch EL, Myers WO. Aspirin sulfinpyrazone in prophylaxis of deep venous thrombosis in total hip replacement. JAMA 1983; 250: 2649-2654
- 7 Belch JJ F, Meek DR, Lowe GD O, Campbell AF, Young AB, Forbes CD, Prentice CR M. Subcutaneous ancrod in prevention of deep vein thrombosis after hip replacement surgery. Thromb Res 1982; 25: 23-31
- 8 Welin-Berger T, Bygdeman S, Mebius C. Deep vein thrombosis following hip surgery. Relation to activated factor X inhibitor activity: effect of heparin and dextran. Acta Orth Scand 1982; 53: 937-945
- 9 Fredin HO, Nillius A. Fatal pulmonary embolism after total hip replacement. Acta Orth Scand 1982; 53: 407-411
- 10 Turpie AG G, Levine MN, Hirsh J, Carter C, Jay RM, Powers PJ, Andrew M, Hull R, Gent M. A randomized controlled trial of PK 10169 low molecular weight heparin in the prevention of deep vein thrombosis in patients undergoing elective hip surgery. N Engl J Med 1986; 315: 925-929
- 11 Francis CW, Marder VJ, McCollister Evarts CM, Yaukoolboody S. Two-step warfarin therapy. Prevention of postoperative venous thrombosis without excessive bleeding JAMA 1983; 3 (249) 374-378
- 12 Leyvraz R, Richard J, Bachmann F, van Melle C, Treyvand JM, Livio JJ, Candardjis G. Adjusted versus fixed-dose subcutaneous heparin in the prevention of deep vein thrombosis after total hip replacement. N Engl J Med 1983; 309: 954-958
- 13 Collins R, Scrimgeour A, Yusuf S, Peto R. Reduction of fatal pulmonary embolism and venous thrombosis by perioperative administration of subcutaneous heparin. N Engl J Med 1988; 318: 1162-1173
- 14 Powers PJ, Gent M, Jay RM, Julian DH, Turpie AG G, Levine M, Hirsh J. A randomized trial of less intensive postoperative warfarin or aspirin therapy in the prevention of venous thromboembolism after surgery for fractured hip. Arch Intern Med 1989; 149: 771-774
- 15 Paiement G, Wessinger SJ, Waltman AC, Harris WH. Surveillance of deep vein thrombosis in asymptomatic total hip replacement patients: Impedance phlebography and fibrinogen scanning versus roentgenographic phlebography. Am J Surg 1988; 155: 400-404
- 16 Hoek JA, Lensing AW A, Borm JJ J, ten Cate JW, Nurmohamed MT, Cogo A, Ling E. The clinical utility of objective diagnostic tests for diagnosing deep vein thrombosis of the leg. Br J Clin Pract 1989; (Suppl. 65) 1: 26-35
- 17 Hoek JA, Nurmohamed MT, Hamelynck KJ, Marti RK. Prevention of deep vein thrombosis following total hip replacement by a low molecular weight heparinoid (Org 10172) (submitted).
- 18 Rabinov K, Paulin S. Röntgen diagnosis of venous thrombosis in the leg. Arch Surg 1972; 104: 133-144
- 19 Turner DA. An intuitive approach to receive operating characteristic curve analysis. J Nucl Med 1978; 19: 213-220
- 20 Hanley JA, McNeil BJ. The meaning and use of the area under a received operating characteristic ROC curve. Radiology 1982; 143: 29-36