Study On The Predictive Role Of Thromboelastography In Deep Vein Thrombosis Of Lower Extremity After Total Knee Arthroplasty

Objective:By analyzing the changes of thromboelastogram(TEG)and routine coagulation indexes of patients undergoing total knee arthroplasty(TKA)before and 1 day after operation,and combining with the results of color Doppler ultrasound of deep veins of lower extremities before and 1 day after operation,to explore the predictive value of TEG on the formation of deep vein thrombosis of lower extremities(LEDVT)after TKA,so as to provide a reference for clinical intervention in LEDVT.Methods:Through screening and retrospective analysis of 80 patients who received TKA in our hospital from July 2022 to March 2023,a total of 66 cases were screened out,excluding cases with incomplete data and severe malformations and difficult surgery,we divided them into 33 cases in LEDVT formation group and 33 cases in LEDVT non-formation group,and collected their TEG parameters before and 1 day after surgery: coagulation factor action time(R),initial time of blood clot formation(K),blood clot formation rate(Angle),maximum amplitude of blood clot(MA);As well as routine coagulation test indicators: prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(Fg),D-dimer(D-D),platelet(PLT).SPSS 26.0 software was used for statistical analysis.Measurement data conforming to normal distribution were represented by(mean ± standard deviation).Two independent samples T-test was used for inter-group comparison,paired T-test was used for intra-group comparison,pearson correlation analysis was used for data conforming to normal distribution and separman correlation analysis was used for data incompatible with normal distribution.Results:There were no significant differences in age,gender and body mass index between LEDVT formation group and non-Le DVt formation group(P > 0.05).TEG parameters and conventional coagulation parameters in LEDVT group were significantly changed before and after surgery(P < 0.05).Among TEG parameters and conventional coagulation parameters before and after operation in the group without LEDVT formation,only K value had the most significant change(P < 0.05).There were no significant differences in preoperative indexes between the two groups(P > 0.05).The parameters of R,K,Angle,MA,PT,APTT,TT and Fg were significantly different between the two groups after surgery(P < 0.05),while the two indexes of D-D and PLT were not significantly different(P > 0.05).Correlation analysis between TEG parameters and conventional coagulation indexes showed that: R and TT was positively correlation(R = 0.264,P < 0.05),MA and Fg was positively correlation(R = 0.309,P < 0.05),Angle and Fg was positively correlation(R =0.247,P < 0.05),and the rest did not find significant correlation,0<| r |<0.3 showed low correlation;0.3 ≤ | r | < 0.8 showed moderate correlation;0.8 ≤ | r | < 1 showed high correlation.The ROC curve results indicate that the AUC values of each TEG parameter are higher than those of conventional coagulation tests.Conclusion:TEG parameters R,K,Angle,MA and routine blood coagulation tests PT,APTT,TT,Fg have certain value in the diagnosis of LEDVT formation,and TEG parameters are superior to routine blood coagulation test indicators in the diagnosis of LEDVT formation,especially the diagnostic efficiency of MA value is higher.