Biomarkers of Coagulation and Fibrinolysis during Cemented Total Hip Arthroplasty with Pre- versus Postoperative Start of Thromboprophylaxis

Abstract

Venous thrombosis is common in elective hip surgery, and prophylaxis is recommended. Clinical trials suggest that the drug dose and timing of initiating prophylaxis significantly influence antithrombotic effectiveness and safety. We studied the time course and gradient of plasma coagulation and fibrinolysis during total hip arthroplasty (THA) in twenty patients that were randomly assigned to have the first dose of 5000 IU dalteparin subcutaneously (sc) injected 12 hours before or 6 hours after surgery. Baseline characteristics were similar in both groups. Specific biomarkers on coagulation (prothrombin fragment 1+2 (F1+2)) and fibrinolytic activity (plasmin/α2-antiplasmin complex (PAP) and D-dimer) were collected at six events during hospitalization and analysed. There were no significant group differences in the biomarkers at any time point. The highest concentrations were measured 6 hours after surgery and before the first postoperative injection. A marked decrease followed at the first postoperative day, and then a second increase in plasma concentrations was observed 6 days after surgery. This study showed that activation of coagulation and fibrinolysis by the operative trauma was the same when the first dose of dalteparin was injected 12 hours before or 6 hours after surgery.

Additional Dose of Intravenous Tranexamic Acid after Primary Total Knee Arthroplasty Further Reduces Hidden Blood Loss

“…[ 1 2 ] Recent studies suggested that prolonged fibrinolytic activity from delayed activation of plasmin beyond the initial surgical trauma might be a potential cause for HBL. [ 3 4 5 ]…”

Low-molecular-weight heparin for hip fracture patients treated with osteosynthesis: should thromboprophylaxis start before or after surgery? An observational study of 45,913 hip fractures reported to the Norwegian Hip Fracture Register

“…2009, Borgen et al. 2013). In Europe the LMWH prophylaxis has traditionally started before hip fracture surgery (Ettema et al.…”

Tranexamic acid use during total hip arthroplasty

“…Shortly after this period, the activity of t-PA decreases during a fibrinolytic shutdown phase due to a release of tissue plasminogen activator inhibitor-I (t-PAI), an acute phase reactant that naturally limits fibrinolysis. [34,37,66,67] Thus, the use of TXA can be utilized preoperatively or within the early intraoperative phase to combat the enhanced release of t-PA during surgery. TXA administered more than 24 hours post-surgery may cause over-inhibition of fibrinolytic activity due to the combined effects of TXA and t-PAI, possibly resulting in vaso-occlusive events (VOE) such as deep vein thrombosis (DVT) and pulmonary embolism (PE).…”