Higher preoperative Caprini scores and D-dimer levels predict higher DVT risk in primary TKA patients: Study

A new study by Liang Qiao and team showed that deep vein thrombosis (DVT) was shown to be strikingly more common in primary total knee arthroplasty (TKA) patients with a preoperative Caprini score of ≥ 4 and D-dimer values of ≥ 1.0 mg/L. The findings of this study were published in the Journal of Orthopaedic Surgery and Research.

D-dimer and the Caprini score are well-known indicators for assessing deep vein thrombosis. However, due to their vulnerability to different post-operative circumstances, their usefulness in directing post-arthroplasty DVT risk is limited, making them less effective as reminders. Also, these indicators are more stable prior to surgery. In spite of this, there is a dearth of studies on the pre-operative prognostic usefulness of the D-dimer and Caprini score for DVT after primary total knee arthroplasty (TKA).

This study examined patient data from individuals who had primary TKA between August 2015 and December 2022 in a retrospective research. Caprini scores were evaluated upon admission, and complete blood panels were collected from fasting blood samples. vascular Doppler ultrasonography OF Lower limb was done on every patient before to surgery in order to rule out any patients who already had DVT, and all patients had another DVT evaluation after surgery.

A total of 2,873 patients, 676 males and 2,197 women, with an average age of 67.98 ± 7.54 years, were included in this study. In this research, 57 (1.98%) instances had lower limb symptoms, and 303 (10.55%) patients had postoperative DVT. Significant differences (P < 0.05) were seen in the incidence of DVT among patients with pre-operative Caprini scores of 1-2 (6.50%), 3 (10.28%), and ≥ 4 (18.05%). Individuals with pre-operative D-dimer levels ≥ 1 mg/L had a greater risk of DVT (14.8%) than the individuals with values < 0.5 mg/L (8.98%) and 0.5–1 mg/L (10.61%) (P < 0.05).

Postoperative DVT occurred in only 5.84% of patients with D-dimer levels < 0.5 mg/L and Caprini ratings of 1-2. The postoperative DVT incidence rate increased to 24.81% for patients with Caprini scores > 4 and D-dimer levels ≥ 1.0 mg/L, with an odds ratio (OR) of 4.744 when compared to the previous group.

After TKA, tge patients with higher preoperative Caprini scores and D-dimer had a greater risk of developing DVT. Also, the ones who have a preoperative Caprini score of > 4 and a D-dimer level of ≥ 1.0 mg/L are considered high-risk for DVT after TKA, with a considerably higher probability of having DVT (24.81%). These results have important implications for preoperative DVT risk reduction strategy and DVT risk categorization in main TKA patients.

Source:

Qiao, L., Yao, Y., You, X., Wu, D., Tsai, H., Zhou, G., Xu, Z., & Jiang, Q. (2024). Identifying high-risk groups for deep vein thrombosis after primary total knee arthroplasty using preoperative Caprini scores and D-dimer levels. In Journal of Orthopaedic Surgery and Research (Vol. 19, Issue 1). Springer Science and Business Media LLC. https://doi.org/10.1186/s13018-024-05074-3