Circulation Journal
Online ISSN : 1347-4820
Print ISSN : 1346-9843
ISSN-L : 1346-9843
Peripheral Vascular Disease
Utility of Noninvasive Endothelial Function Test for Prediction of Deep Vein Thrombosis After Total Hip or Knee Arthroplasty
Hiroyuki Suzuki, Yasushi Matsuzawa, Masaaki Konishi, Eiichi Akiyama, Keiko Takano, Naoki Nakayama, Shunsuke Kataoka, Toshiaki Ebina, Masami Kosuge, Kiyoshi Hibi, Kengo Tsukahara, Noriaki Iwahashi, Mitsuaki Endo, Nobuhiko Maejima, Kentaro Shinohara, Naoya Taki, Naoto Mitsugi, Masataka Taguri, Seigo Sugiyama, Hisao Ogawa, Satoshi Umemura, Kazuo Kimura
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Keywords: Arthroplasty, Endothelial function, Venous thromboembolism
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2014 Volume 78 Issue 7 Pages 1723-1732

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Abstract

Background: Venous thromboembolism (VTE) is a common and sometimes lethal postoperative complication of arthroplasty. Endothelial dysfunction is important in the pathogenesis of thrombus formation. Reactive hyperemia-peripheral arterial tonometry (RH-PAT) can noninvasively evaluate endothelial function. This study investigated the predictive value of RH-PAT for deep vein thrombosis (DVT) after lower limb arthroplasty. Methods and Results: A prospective observational study of 126 osteoarthritic patients who underwent total knee arthroplasty (TKA) or hip arthroplasty (THA) was conducted. The RH-PAT index (RHI) was measured on the day before surgery, and presence of DVT was checked by ultrasonography or phlebography before and after surgery. Following arthroplasty, DVT was diagnosed in 51 patients (40.5%). RHI in the DVT group (0.58±0.25) was significantly lower than in the non-DVT group (0.71±0.25, P=0.004). RHI was a significant and independent predictor of postoperative DVT in multivariate logistic regression analyses and improved a net reclassification index (23.8%, P=0.022). Subgroup analyses according to operation site with adjustment for Qthrombosis score demonstrated that RHI significantly predicted postoperative DVT in the THA group (odds ratio per 0.1, 0.77; 95% confidence interval 0.60–0.98; P=0.03), but did not reach statistical significance in the TKA group. Conclusions: Low RHI was significantly associated with DVT after lower limb arthroplasty. Endothelial dysfunction, as assessed by RH-PAT, is potentially useful for identifying patients at high risk for VTE especially after THA.  (Circ J 2014; 78: 1723–1732)

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© 2014 THE JAPANESE CIRCULATION SOCIETY
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