Complex analysis of coagulation tests in patients undergoing the combination of hemostatic and antithrombotic therapy following large joint arthroplasty
- Authors: Golovko LS1, Safronenko AV1, Gantsgorn EV1, Sukhorukova NV1, Maklyakov YS1
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Affiliations:
- Rostov State Medical University
- Issue: Vol 101, No 4 (2020)
- Pages: 489-500
- Section: Theoretical and clinical medicine
- URL: https://ogarev-online.ru/kazanmedj/article/view/21238
- DOI: https://doi.org/10.17816/KMJ2020-489
- ID: 21238
Cite item
Abstract
Aim. To assess the dynamics of coagulation parameters and the influence of its initial values on the development of postoperative thrombohemorrhagic complications in male and female patients undergoing large joint arthroplasty and received combination hemostatic and anticoagulant therapy.
Methods. A retrospective analysis of the medical records (n=253) of patients with arthroplasty, were divided into two groups based on the time differences between prescription of hemostatic and anticoagulation therapy. The first group includes 145 patients (57.31%, 112 women and 33 men) with time differences ≤17 h, and the second group includes 108 patients (42.68%, 78 women and 30 men) with time differences 18–24 h. The dynamics of coagulation test results were analyzed, and the influence of its initial value on the risk of postoperative thrombosis or bleeding was assessed.
Results. Thrombohemorrhagic complications were recorded in 27 (10.67%) patients, of which 22 (81.48%) were observed in group 1. In the first group, thrombosis developed in regimens with tranexamic acid (p=0.038) with 2.2 times higher incidence than in group 2 (p=0.023). The risk of thrombosis of women in the group 1 was increased by an initially low level of international normalized ratio [relative risk (RR) 13.333, p=0.00032] and activated partial thromboplastin time (RR=5.8, p=0.037). The risk of bleeding in group 1 increased by an increasing preoperative level of activated partial thromboplastin time (RR=18, p=0.0012 and RR=28, p=0.00022, respectively) for all patients and by a decreasing fibrinogen level (RR=23.25, p=0.00065) and platelets count (RR=10.2, p=0.038) for women.
Conclusion. To minimize the risks of thrombosis and bleeding after arthroplasty, especially in patients with initial deviations of hemostasis parameters from the norm, and, in particular, when using tranexamic acid as a hemostatic agent, it is recommended to observe the time interval between hemostatic and anticoagulant pharmacotherapy for at least 18 hours.
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##article.viewOnOriginalSite##About the authors
L S Golovko
Rostov State Medical University
Author for correspondence.
Email: liliya_s_golovko@mail.ru
Russian Federation, Rostov-on-Don, Russia
A V Safronenko
Rostov State Medical University
Email: liliya_s_golovko@mail.ru
Russian Federation, Rostov-on-Don, Russia
E V Gantsgorn
Rostov State Medical University
Email: liliya_s_golovko@mail.ru
Russian Federation, Rostov-on-Don, Russia
N V Sukhorukova
Rostov State Medical University
Email: liliya_s_golovko@mail.ru
Russian Federation, Rostov-on-Don, Russia
Y S Maklyakov
Rostov State Medical University
Email: liliya_s_golovko@mail.ru
Russian Federation, Rostov-on-Don, Russia
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