Predicting Pulmonary Embolism in Total Joint Arthroplasty Patients A Pilot Study

Bull Hosp Jt Dis (2013). 2024 Jun;82(2):124-133.

Abstract

Postoperative venous thromboembolism (VTE) is a common and costly complication following total joint arthroplasty (TJA). Development of a refined thrombophilic screening panel will better equip clinicians to identify patients at high-est risk for developing VTEs. In this pilot study, 62 high-risk TJA recipients who had developed pulmonary emboli (PE) within 90-days of surgery were eligible to participate. Of these patients, 14 were enrolled and subsequently adminis-tered a pre-determined panel of 18 hematologic tests with the aim of identifying markers that are consistently elevated or deficient in patients developing PE. A separate cohort of seven high-risk TJA recipients who did not report a symp-tomatic VTE within 90-days of surgery were then enrolled and Factor VIII and lipoprotein(a) levels were assessed. The most common aberrance was noted in 10 patients (71.4%) who had elevated levels of Factor VIII followed by five patients (35.7%) who had elevated levels of lipoprotein(a). Factor VIII was significantly prevalent (p < 0.001) while lipoprotein(a) failed to achieve statistical significance (p = 0.0708). Of the patients who were within normal limits of Factor VIII, three-fourths were "high-normal" with Fac-tor VIII levels within 5% of the upper limit of normal. This study demonstrates the potential utility of this hematologic panel as part of a perioperative screening protocol aimed at identifying patients at risk for developing VTEs. However, future larger scale studies assessing the capabilities and limitations of our findings are warranted.

MeSH terms

  • Aged
  • Arthroplasty, Replacement / adverse effects
  • Biomarkers / blood
  • Factor VIII / analysis
  • Female
  • Humans
  • Lipoprotein(a) / blood
  • Male
  • Middle Aged
  • Pilot Projects
  • Postoperative Complications / blood
  • Postoperative Complications / diagnosis
  • Postoperative Complications / etiology
  • Predictive Value of Tests
  • Pulmonary Embolism* / blood
  • Pulmonary Embolism* / diagnosis
  • Pulmonary Embolism* / etiology
  • Risk Assessment / methods
  • Risk Factors
  • Venous Thromboembolism / blood
  • Venous Thromboembolism / diagnosis
  • Venous Thromboembolism / epidemiology
  • Venous Thromboembolism / etiology

Substances

  • Factor VIII
  • Biomarkers
  • Lipoprotein(a)