Relationships of serum thrombin activatable fibrinolysis inhibitor and angiopoietin Ⅱwith postoperative deep vein thrombosis in patients with traumatic fractures
Objective To observe the changes in preoperative levels of thrombin activatable fibrinolysis inhibitor(TAFI)and angiopoietin Ⅱ(Ang Ⅱ)in patients with traumatic fractures,and to explore their values to the prediction of postoperative deep vein thrombosis(DVT).Methods A total of 185 patients with traumatic fractures underwent surgical treatment in Zhengzhou Orthopedic Hospital from July 2022 to August 2023.The lower limb vascular ultrasound examination before surgery showed no DVT.The serum levels of TAFI and Ang Ⅱ were detected by ELISA on the day before surgery.The lower limb vascular ultrasound examination was done again 14 d after surgery,showing 95 patients with DVT(DVT group)and 90 patients with no DVT(non-DVT group).The gender ratio,age,body mass index,smoking habits,alcohol consumption history,fracture site,preoperative prothrombin time,activated partial thromboplastin time,thrombin time,fibrinogen,and serum levels of TAFI and Ang Ⅱ were compared between two groups.Multivariate logistic regression was applied to analyze the influencing factors of postoperative DVT in patients with traumatic fractures.ROC curves were plotted to evaluate the efficiencies of preoperative serum TAFI and Ang Ⅱ on predicting postoperative DVT in patients with traumatic fractures.Results(1)The preoperative prothrombin time,activated partial thromboplastin time and thrombin time were shorter in DVT group[(12.78±1.98),(20.76±1.23),(24.34±3.54)s]than those in non-DVT group[(15.98±1.23),(24.45±2.03),(31.39±5.87)s](P＜0.05),the levels of fibrinogen,TAFI and Ang Ⅱ were higher in DVT group[(1.70±0.22)g/L,(33.44±5.43)mg/L,(4.00± 0.95)μg/L]than those in non-DVT group[(1.39±0.23)g/L,(27.34±6.32)mg/L,(3.02±0.87)μg/L](P＜0.05),and there were no significant differences in the age,body mass index,male ratio,and percentages of patients with,smoking habits,alcohol consumption history,and different fracture sites between two groups(P＞0.05).(2)Preoperative activated partial thromboplastin time(OR=0.363,95％CI:0.269-0.490,P＜0.001),fibrinogen(OR=5.034,95％CI:1.425-17.787,P=0.012),TAFI(OR=8.152,95％CI:2.108-31.521,P=0.002),and Ang Ⅱ(OR=2.532,95％CI:1.567-4.062,P＜0.001)were the influencing factors of postoperative DVT in patients with traumatic fractures.(3)When the optimal cut-off values of preoperative serum TAFI and Ang Ⅱ in patients with traumatic fractures were 32.163 mg/L and 3.440 μg/L,the AUCs for predicting postoperative DVT were 0.738(95％CI:0668-0.808,P＜0.001)and 0.739(95％CI:0.668-0.810,P＜0.001),with the sensitivities of 64.6％and 74.2％,and the specificities of 86.7％and 79.6％,respectively.The AUC of combined detection of them two for predicting postoperative DVT was 0.911(95％CI:0.872-0.951,P＜0.001),with a sensitivity of 80.0％and a specificity of 75.9％.The AUC of combined detection was greater than that of either TAFI or Ang Ⅱ(Z=4.201,P＜0.001;Z=4.177,P＜0.001).Conclusion Traumatic fracture patients with elevated preoperative serum TAFI and Ang Ⅱ levels are prone to DVT,and the combined detection of them two has a high predictive value.
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