Postoperative Activation of the Haemostatic System - Influence of Prolonged Thromboprophylaxis in Patients Undergoing Total Hip Arthroplasty

Andersen, B

doi:10.1159/000217460

“…In agreement with other authors [23,24] we found significantly increased levels of F1j2 as marker for thrombin generation after hip arthroplasty. This activation should be reflected by elevated β-TG and F1j2 levels post-operatively.…”

Section: Discussionsupporting

confidence: 93%

Increases in circulating levels of monocyte–platelet and neutrophil–platelet complexes following hip arthroplasty

Bunescu¹,

Widman

²

,

Lenkei³

et al. 2002

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Platelets and leucocytes are important effector cells of the haemostatic and inflammatory responses to tissue injury. To investigate the effects of surgical trauma on platelet activation (assessed by measuring levels of P-selectin and beta-thromboglobulin), leucocyte activation (CD11b expression) and leucocyte-platelet interactions (leucocyte-platelet complexes), 30 patients undergoing primary hip arthroplasty were studied before and at the end of surgery, and on days 1 and 10 post-operatively, using a whole-blood flow cytometry assay. The inflammatory response was followed by measurement of the levels of C-reactive protein and interleukin-6 in plasma, and the activation of coagulation was monitored by determination of prothrombin fragment 1+2 levels. On day 1 post-operatively a significantly increased expression of CD11b on monocytes was noted, but no direct correlation was found between monocyte activation and interleukin-6 production or C-reactive protein at this time point. The percentage of monocyte-platelet and neutrophil-platelet complexes was markedly increased on day 10 post-operatively compared with pre-operative levels, and levels of these complexes were significantly positively correlated with beta-thromboglobulin levels. Activation of coagulation (prothrombin fragment 1+2) on day 10 post-operatively was positively correlated with the extent of surgical trauma (duration of surgery, amount of blood loss) and with the increase in platelet activation (beta-thromboglobulin). In conclusion, hip arthroplasty induces platelet and coagulation activation, and also an inflammatory response that is maintained for more than 10 days post-operatively. This indicates an interaction between the immune and the haemostatic systems in the post-operative phase after hip arthroplasty.

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“…This activation should be reflected by elevated β-TG and F1j2 levels post-operatively. In agreement with other authors [23,24] we found significantly increased levels of F1j2 as marker for thrombin generation after hip arthroplasty. Increases in F1j2 and β-TG on day 10 post-operatively could have been due to the fact that the treatment with lowmolecular-mass heparin was withdrawn on day 5.…”

Section: Discussionsupporting

confidence: 93%

Increases in circulating levels of monocyte‒platelet and neutrophil‒platelet complexes following hip arthroplasty

BUNESCU¹,

Widman

²

,

LENKEI³

et al. 2002

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Platelets and leucocytes are important effector cells of the haemostatic and inflammatory responses to tissue injury. To investigate the effects of surgical trauma on platelet activation (assessed by measuring levels of P-selectin and beta-thromboglobulin), leucocyte activation (CD11b expression) and leucocyte-platelet interactions (leucocyte-platelet complexes), 30 patients undergoing primary hip arthroplasty were studied before and at the end of surgery, and on days 1 and 10 post-operatively, using a whole-blood flow cytometry assay. The inflammatory response was followed by measurement of the levels of C-reactive protein and interleukin-6 in plasma, and the activation of coagulation was monitored by determination of prothrombin fragment 1+2 levels. On day 1 post-operatively a significantly increased expression of CD11b on monocytes was noted, but no direct correlation was found between monocyte activation and interleukin-6 production or C-reactive protein at this time point. The percentage of monocyte-platelet and neutrophil-platelet complexes was markedly increased on day 10 post-operatively compared with pre-operative levels, and levels of these complexes were significantly positively correlated with beta-thromboglobulin levels. Activation of coagulation (prothrombin fragment 1+2) on day 10 post-operatively was positively correlated with the extent of surgical trauma (duration of surgery, amount of blood loss) and with the increase in platelet activation (beta-thromboglobulin). In conclusion, hip arthroplasty induces platelet and coagulation activation, and also an inflammatory response that is maintained for more than 10 days post-operatively. This indicates an interaction between the immune and the haemostatic systems in the post-operative phase after hip arthroplasty.

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“…Similar differences have been reported previously [3,29]. Reasonable mechanisms for late-occurring VTE have been related to prolonged activation of the coagulation system [35,36]. A prolonged reduction in venous outflow has also been described, persisting for 6 weeks after hip replacement [37,38] but normalizing during the first week after knee replacement [39], differences that possibly could be explained by the use of tourniquet and the associated venous stasis and more extensive soft-tissue damage in knee replacement surgery, leading to extensive local release of tissue factor [12].…”

Section: Discussionsupporting

confidence: 83%

Symptomatic venous thromboembolism and mortality in orthopaedic surgery – an observational study of 45 968 consecutive procedures

Lapidus

¹

,

Ponzer

²

,

Pettersson

³

et al. 2013

BMC Musculoskelet Disord

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BackgroundLittle information exists on the presentation of symptomatic venous thromboembolism (VTE) in orthopaedic surgery when a defined protocol for thromboprophylaxis is used. The objective with this study was to establish the VTE rate and mortality rate in orthopaedic surgery.MethodsWe performed a prospective, single centre observational cohort study of 45 968 consecutive procedures in 36 388 patients over a 10 year period. Follow-up was successful in 99.3%. The primary study outcome was the incidence of symptomatic deep vein thrombosis (DVT), symptomatic pulmonary embolism (PE) and mortality at 6 weeks, specified for different surgical procedures. The secondary outcome was to describe the DVT distribution in proximal and distal veins and the proportion of VTEs diagnosed after hospital discharge. For validation purposes, a retrospective review of VTEs diagnosed 7–12 weeks postoperatively was also performed.ResultsIn total, 514 VTEs were diagnosed (1.1%; 95% CI: 1.10-1.14), the majority (84%) after hospital discharge (432 out of 514).With thromboprophylaxis, high incidence of VTE was found after internal fixation (IF) of pelvic fracture (12%; 95% CI: 5–26), knee replacement surgery (3.7%; 95% CI: 2.8-5.0), after internal fixation (IF) of proximal tibia fracture (3.8%; 95% CI: 2.3-6.3) and after IF of ankle fracture (3.6%; 95% CI: 2.9-4.4). Without thromboprophylaxis, high incidence of VTE was found after Achilles tendon repair (7.2%; 95% CI: 5.5-9.4). In total 1094 patients deceased (2.4%; 95% confidence interval (CI): 2.33- 2.44) within 6 weeks of surgery. Highest mortality was seen after lower limb amputation (16.3%, CI: 13.8-19.1) and after hip hemiarthroplasty due to hip fracture (9.6%, CI; 7.6-12.1).ConclusionThe overall incidence of VTE is low after orthopaedic surgery but our study highlights surgical procedures after which the risk for VTE remains high and improved thromboprophylaxis is needed.

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Postoperative Activation of the Haemostatic System - Influence of Prolonged Thromboprophylaxis in Patients Undergoing Total Hip Arthroplasty

Cited by 9 publications

References 11 publications

Increases in circulating levels of monocyte–platelet and neutrophil–platelet complexes following hip arthroplasty

Increases in circulating levels of monocyte–platelet and neutrophil–platelet complexes following hip arthroplasty

Increases in circulating levels of monocyte‒platelet and neutrophil‒platelet complexes following hip arthroplasty

Symptomatic venous thromboembolism and mortality in orthopaedic surgery – an observational study of 45 968 consecutive procedures

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