effect of preoperative activation hemostasis on the dynamics of coagulation and fibrinolysis post large joint arthroplasty

Abstract

The prediction and diagnosis of thromboembolic complications in extensive orthopedic surgery pose a serious problem. Solving this problem becomes important in the study of the functioning of the hemostatic system. The study of the functioning hemostatic system is important for solving this problem. We investigated the effect of the pre-operative activity of fibrin formation and fibrinolysis on the dynamics of hemostasis, post primary hip or knee arthroplasty. This prospective study included 102 patients, segregated into two groups: The 1st group of 51 patients was characterized by the preoperative activity of the formation of fibrin degradation products (D-dimer) in the normal range (<250ng/mL) with a mean value of 153±55 ng/mL; the 2nd group of 51 patients had an initial D-dimer concentration above the norm, with a mean value of 470±201 ng/mL. Otherwise, the groups were equal with respect to gender, localization of the operated segment, and type of anesthesia. This study was performed prior to surgery, and days 1, 3, 7, 14, post arthroplasty. The coagulation parameters, fibrinolysis, and physiological anticoagulants were determined. Patients of the 2nd group were older than the patients of the 1st group: 51.7±9.7 years vs. 57.0±10.7 years, p<0.05. In the 2nd group, patients with higher initial levels of fibrin formation and lysis, showed retention of higher D-dimer concentrations after day 1 post surgery (1,447±478 ng/mL vs 1,202±594 ng/mL in the 1st group, p<0.05) and after day 3, post surgery. However, by day 7, the differences were leveled. No significant differences in the TAT, plasminogen and PAI-1 levels were observed during the entire study. No significant differences were noted in the number of verified thromboses of the deep veins, which was 17.5% in the 1st group and 16.1% in the 2nd group. The initial increase in the degree of fibrin formation and fibrinolysis did not raise the risk of thromboembolic complications during hip and knee arthroplasty.