title: Enhanced pre-operative thrombolytic status is associated with the incidence of deep venous thrombosis in patients undergoing total knee arthroplasty.
abstract: BACKGROUND
  Deep venous thrombosis (DVT), which is often associated with pulmonary embolism (PE), is a serious complication after total knee arthroplasty (TKA). In the present study, we examined the overall thrombotic and thrombolytic status using Global Thrombosis Test (GTT) in non-anticoagulated blood of patients undergoing TKA to develop the predictable marker for the incidence of DVT.
  
  
  METHODS
  DVT was diagnosed using doppler ultrasonography a day after the surgery in 31 patients with osteoarthritis (n = 24), rheumatoid arthritis (n = 6) and ankylosing spondylitis (n = 1) by the well-trained operator. We measured overall thrombotic and thrombolytic status using GTT and other biomarkers, which is associated with blood coagulation and fibrinolysis, before and immediately after the surgery.
  
  
  RESULTS
  Newly-generated DVT during the operation was detected in 11 of 31 patients (35.4%) 1 day after TKA. There were no differences in markers of coagulation (PT and APTT), platelet activity (platelet aggregation-induced by ADP and collagen) and fibrinolysis (FDP and D-dimer) between non-DVT and DVT group both before and after the surgery. Both Pre- and Post-operative GTT-occlusion times (OT), an index of platelet reactivity, were tended to be shorter, but not significant, in DVT group compared with non-DVT group. Pre-operative GTT-lysis time (LT), an index of thrombolytic activity, was significantly shorter in DVT group compared with non-DVT group, while there were no differences in post-operative value of this index between DVT group and non-DVT group, suggesting overall thrombolytic activity was enhanced in DVT group before surgery.
  
  
  CONCLUSIONS
  Our data suggest that enhancement of pre-operative thrombolytic activity assessed by GTT may be a predictable marker for the incidence of DVT after TKA.
authors.affiliation: Department of Physiology and Regenerative Medicine, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan.
authors.forename: Yukinori
authors.initials: Y
authors.lastname: Tamura
authors.affiliation: Department of Orthopaedic Surgery, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan.
authors.forename: Shigeshi
authors.initials: S
authors.lastname: Mori
authors.affiliation: Department of Orthopaedic Surgery, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan.
authors.forename: Shigeki
authors.initials: S
authors.lastname: Asada
authors.affiliation: Department of Physiology and Regenerative Medicine, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan.
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kawao
authors.affiliation: Department of Food Science and Nutrition, Kinki University Faculty of Agriculture, 3327-204 Nakamachi, Nara 631-0052, Japan.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Ueshima
authors.affiliation: Department of Physiology and Regenerative Medicine, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kaji
authors.affiliation: Lab oratory of Physiology, Faculty of Nutrition, Kobe Gakuin University, 518 Arise, Igawadani-cho, Nishi-ku, Kobe 651-2180, Japan.
authors.forename: Junichiro
authors.initials: J
authors.lastname: Yamamoto
authors.affiliation: Department of Orthopaedic Surgery, Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama, Osaka 589-8511, Japan.
authors.forename: Masao
authors.initials: M
authors.lastname: Akagi
authors.affiliation: Kinki University Faculty of Medicine, 377-2 Ohnohigashi, Osakasayama 589-8511, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsuo
keywords: Deep venous thrombosis; Global thrombosis test; Thrombolysis