Download PDF
Thromb Haemost 1999; 81(06): 879-886
DOI: 10.1055/s-0037-1614592
Letters to the Editor
Schattauer GmbH

Prediction of Deep Vein Thrombosis after Elective Hip Replacement Surgery by Preoperative Clinical and Haemostatic Variables: The ECAT DVT Study

Gordon D. O. Lowe
1   From the University Department of Medicine, Royal Infirmary, Glasgow, UK
,
Frits Haverkate
2   TNO Prevention and Health, Gaubius Laboratory, Leiden, The Netherlands
,
Simon G. Thompson
3   Department of Medical Statistics and Evaluation, Imperial College School of Medicine, London, UK
,
Rebecca M. Turner
3   Department of Medical Statistics and Evaluation, Imperial College School of Medicine, London, UK
,
Rogier M. Bertina
4   Haemostasis and Thrombosis Research Center, Academisch Ziekenhuis, Leiden, The Netherlands
,
Alexander G. G. Turpie
5   HGH - McMaster Clinic, Hamilton, Canada
,
Pier M. Mannucci   *
6   IRCCS Maggiore Hospital, Milan, Italy
,
on behalf of the ECAT DVT Study Group › Author Affiliations
Further Information

Publication History

Received 29 September 1998

Accepted after revision 05 March 1999

Publication Date:
09 December 2017 (online)

    Permissions and Reprints

Summary

The European Concerted Action on Thrombosis (ECAT) DVT Study was a collaborative study of preoperative haemostatic tests in prediction of DVT (diagnosed by routine bilateral venography) after elective hip replacement. 480 patients were recruited in 11 centres across Europe. Clinical risk factors were assessed, and stored citrated plasma aliquots were centrally assayed for 29 haemostatic factors according to the ECAT methodology. 120 (32%) of 375 evaluable patients had DVT, and 41 (11%) had proximal DVT. Among clinical variables, DVT was significantly associated with increased age, obesity, and possibly non-use of stockings. Of the 29 haemostatic factors, mean preoperative levels were significantly higher in patients with subsequent DVT (on univariate analyses) for factor VIII activity, prothrombin fragment F1+2, thrombin-antithrombin complexes, and fibrin D-dimer; and significantly lower for APTT and APC sensitivity ratio. Factor V Leiden was also associated with DVT. Most of these variables were also associated with age, while D-dimer was higher in patients with varicose veins. On multivariate analyses including clinical variables, only a shorter APTT (locally but not centrally performed) and APC resistance showed a statistically significant association with DVT.

We conclude that (a) DVT is common after elective hip replacement despite prophylaxis; (b) the study provides some evidence that DVT is associated with a preoperative hypercoaguable state; and (c) preoperative haemostatic tests do not add significantly to prediction of DVT from clinical variables, with the possible exception of APC resistance.

* Names and institutions of Study Group Members are listed in the Appendix (p. 885).


 

  • References

  • 1 Thromboembolic Risk Factors (THRIFT) Consensus Group Risk of and prophylaxis for venous thromboembolism in hospital patients. Br Med J 1992; 305:: 567-74.
    CrossrefPubMedGoogle Scholar
  • 2 Clagett GP, Anderson , Jr. FA, Heit J, Levine MN, Wheeler HB. Prevention of venous thromboembolism. Chest 1995; 108 Supplement 312S-334S.
    CrossrefPubMedGoogle Scholar
  • 3 International Consensus Statement Prevention of venous thromboembolism. Int Angiol 1997; 16:: 3-38.
    PubMedGoogle Scholar
  • 4 Prins MH, Hirsh J. A critical review of the evidence supporting a relationship between impaired fibrinolytic activity and venous thromboembolism. Arch Intern Med 1991; 151: 1721-31.
    CrossrefPubMedGoogle Scholar
  • 5 Lowe GDO. Prediction of postoperative deep-vein thrombosis. Thromb Haemost 1997; 78: 47-52.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Crandon AJ, Peel KR, Anderson JA, Thompson V, McNicol GP. Postoperative deep vein thrombosis: identifying high-risk patients. Br Med J 1980; ii: 343-34.
    PubMedGoogle Scholar
  • 7 Sue-Ling HM, Johnston D, McMahon MJ, Philips PR, Davies JA. Pre-operative identification of patients at high risk of deep venous thrombosis after elective major abdominal surgery. Lancet 1986; i: 1173-6.
    PubMedGoogle Scholar
  • 8 Wilson MG. Orthopaedic surgery. In Prevention of venous thromboembolism Goldhaber SJ. ed New York: Dekker; 1993: 373-404.
    Google Scholar
  • 9 Rocha E, Alfaro MJ, Paramo JA, Canadell JM. Preoperative identification of patients at high risk of deep venous thrombosis despite prophylaxis in total hip replacement. Thromb Haemost 1988; 59: 93-5.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 10 Jespersen J, Bertina RM, Haverkate F. (eds) ECAT assay procedures. A manual of laboratory techniques. Dordrecht: Kluwer; 1992
    Google Scholar
  • 11 Francis RM, Brenkel IJ. Survey of use of thromboprophylaxis for routine total hip replacement by British orthopaedic surgeons. Br J Hosp Med 1997; 57: 427-31.
    PubMedGoogle Scholar
  • 12 Lensing AWA, Buller HR, Hirsh J, ten Cate JW. Diagnosis of deep vein thrombosis in asymptomatic patients. In Prevention of venous thromboembolism. Bergqvist D, Comerota AJ, Nicolaides AN, Scurr JH. (eds) London: Med-Orion; 1994: 73-91.
    Google Scholar
  • 13 Bergqvist D.. Postoperative thromboembolism. Frequency, etiology, prophylaxis. Berlin: Springer-Verlag; 1983
    Google Scholar
  • 14 Barnes RW, Brand RA, Clarke W, Hartley N, Hoak JC. Efficacy of graded compression antiembolism stockings in patients undergoing total hip arthroplasty. Clin Orthop 1978; 132: 61-7.
    PubMedGoogle Scholar
  • 15 Ishak MA, Morley KD. Deep venous thrombosis after total hip arthroplasty; a prospective controlled study to determine the prophylactic effect of graded elastic pressure stockings. Br J Surg 1981; 68: 429-32.
    CrossrefPubMedGoogle Scholar
  • 16 Wells PS, Lensing AWA, Hirsh J. Graduated compression stockings in the prevention of postoperative venous thromboembolism: a meta-analysis. Arch Intern Med 1994; 154: 67-72.
    CrossrefPubMedGoogle Scholar
  • 17 Scurr JH. Graduated compression stockings for the prevention of venous thromboembolism. In Prevention of venous thromboembolism. Bergqvist D, Comerota AJ, Nicolaides AN, Scurr JH. (eds) London: Med-Orion; 1994: 203-8.
    Google Scholar
  • 18 Hume M. Platelet adhesiveness and other coagulation factors in thrombophlebitis. Surgery 1966; 59: 110-6.
    PubMedGoogle Scholar
  • 19 Gallus AS, Hirsh J, Gent M. Relevance of preoperative and postoperative blood tests to postoperative leg-vein thrombosis. Lancet 1973; ii: 805-9.
    PubMedGoogle Scholar
  • 20 Balendra PR.. Deep vein thrombosis of the leg: natural history and haemostatic variables. MD Thesis. University of Belfast: 1990
    Google Scholar
  • 21 Koster T, Blann AD, Briët E, Vandenbroucke JP, Rosendaal FR. Role of clotting factor VIII in effect of von Willebrand factor on occurrence of deep vein thrombosis. Lancet 1995; 345: 152-5.
    CrossrefPubMedGoogle Scholar
  • 22 O’Donnell J, Tuddenham EGD, Manning R, Kemball-Cook G, Johnson D, Laffan M. High prevalence of elevated factor VIII levels in patients referred for thrombophilia screening: role of increased synthesis and relationship to the acute phase reaction. Thromb Haemost 1997; 77: 825-8.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 23 Woolson ST, Zehnder JL, Maloney WJ. Factor V Leiden and the risk of proximal venous thrombosis after total hip arthroplasty. J Arthroplasty 1998; 13: 207-10.
    CrossrefPubMedGoogle Scholar
  • 24 Ryan DH, Crowther MA, Ginsberg JS, Francis CW. Relation of factor V Leiden genotype to risk for acute deep vein thrombosis after joint replacement surgery. Ann Intern Med 1998; 128: 270-6.
    CrossrefPubMedGoogle Scholar
  • 25 Philipp CS, Dilley A, Saidi P, Evatt B, Austin H, Zawadasky J, Harwood D, Elligsen D, Barnhart E, Phillips DJ, Hooper WC. Deletion polymorphism in the angiotensin converting enzyme gene as a thrombophilic risk factor after hip arthroplasty. Thromb Haemost 1998; 80: 869-73.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Lowe GDO, Rumley A, Woodward M, Reid E, Rumley J. Activated protein C resistance and the FV: R506Q mutation in a random population sample: associations with cardiovascular risk factors and coagulation variables. Thromb Haemost 1999. in press
    Google Scholar
  • 27 Clark P, Walker ID, Greer I. Acquired activated protein-C resistance in pregnancy and association with increased thrombin generation and fetal weight. Lancet 1999; 353: 292-3.
    PubMedGoogle Scholar
  • 28 Cofrancesco E, Cortellaro M, Corradi A, Ravasi F, Bertocchi F. Coagulation activation markers in the prediction of venous thrombosis after elective hip surgery. Thromb Haemost 1997; 77: 267-9.
    Article in Thieme ConnectPubMedGoogle Scholar
  • 29 Lip GYH, Lowe GDO, Rumley A, Dunn FG. Increased markers of thrombogenesis in chronic atrial fibrillation: effects of warfarin treatment. Br Heart J 1995; 73: 527-33.
    CrossrefPubMedGoogle Scholar
  • 30 Lee AJ, Fowkes FGR, Lowe GDO, Rumley A. Haemostatic factors, atherosclerosis and risk of abdominal aortic aneurysm. Blood Coagulation and Fibrinolysis 1996; 7: 695-701.
    CrossrefPubMedGoogle Scholar
  • 31 Houghton GR, Papadekis EG, Rizza CR. Changes in blood coagulation after total hip replacement. Lancet 1977; i: 1336.
    PubMedGoogle Scholar
  • 32 Planes A, Vochelle N. Venous stasis and trauma in hip surgery. In Prevention of venous thromboembolism Bergqvist D, Comerota AJ, Nicolaides AN, Scurr JH. (eds) London: Med-Orion; 1994: 57-62.
    Google Scholar
  • 33 Stamatakis JD, Kakkar VV, Sagar S, Lawrence D, Nairn D, Bentley PG. Femoral vein thrombosis and total hip replacement. BMJ 1977; ii: 223-4.
    PubMedGoogle Scholar