Effect of Preoperative Activation Hemostasis on the Dynamics of Coagulation and Fibrinolysis Post Large Joint Arthroplasty

Irina P. Antropova, PhD¹*, Boris G. Yushkov, PhD, ScD², Igor L. Shlykov, PhD, ScD¹, Anatoliy N. Varaksin, PhD, ScD³

1Ural Research Institute of Traumatology and Orthopedics named after V.D. Chaklin

2Institute of Immunology and Physiology, Ural Branch of the RAS

3Institute of Industrial Ecology, Ural Branch of the RAS Yekaterinburg, Russian Federation

*Corresponding author: Irina P. Antropova, PhD, Senior Researcher, Federal State Institution «Ural Research Institute of Traumatology and Orthopedics named after V. D. Chaklin». 7, Bankovsky alley, 620014, Yekaterinburg, Russian Federation. Tel: 7-922-1105359. E-mail:aip.hemolab@mail.ru


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.

D-Dimer; coagulation; fibrinolysis; large joint arthroplasty.
  1. Colwell CW. The ACCP guidelines for thromboprophylaxis in total hip and knee arthroplasty. Orthopedics 2009; 32(12):67-73.
  2. Rafee A, Herlikar D, Gilbert R, Stockwell RC, and McLauchlan GJ.  D-Dimer in the Diagnosis of Deep Vein Thrombosis Following Total Hip and Knee Replacement: A Prospective Study. Ann R Coll Surg Engl 2008; 90(2):123–126.
  3. Toll DB, Oudega R, Vergouwe Y, Moons KG, Hoes AW. A new diagnostic rule for deep vein thrombosis: safety and efficiency in clinically relevant subgroups. Fam Pract 2008; 25(1):3-8.
  4. Geersing GJ, Janssen KJ, Oudega R, Bax L, Hoes AW, Reitsma JB, et al. Excluding venous thromboembolism using point of care D-dimer tests in outpatients: a diagnostic meta-analysis. BMJ  2009; 14; 339:b2990.
  5. Stein PD, Hull RD, Patel KC, Olson RE, Ghali WA, Brant R, et al. D-dimer for the exclusion of acute venous thrombosis and pulmonary embolism: a systematic review. Ann Intern Med 2004; 20; 140(8):589-602.
  6. Momot AP. Principles and algorithms of clinical and laboratory diagnosis of hemostasis disorders. Barnaul AGMU, 2004. [in Russian].
  7. Harper PL, Theakston E, Ahmed J, Ockelford P. D-dimer concentration increases with age reducing the clinical value of the D-dimer assay in the elderly. Intern Med J 2007; Sep; 37(9):607-13.
  8. Douma RA, le Gal G, Söhne M, Righini M, Kamphuisen PW, Perrier A, et al. Potential of an age adjusted D-dimer cut-off value to improve the exclusion of pulmonary embolism in older patients: a retrospective analysis of three large cohorts. BMJ 2010; 30; 340: 1475.
  9. Craven S, Dewar L, Yang X, Ginsberg J, Ofosu F. Altered regulation of in-vivo coagulation in orthopedic patients prior to knee or hip replacement surgery. Blood Coagul Fibrinolysis 2007; 18(3):219-25.
  10. Peternel P, Terbizan M, Tratar G, Bozic M, Horvat D, Salobir B, et al. Markers of  hemostatic system activation during treatment of deep vein thrombosis with subcutaneous unfractionated or low-molecular weight heparin. Thromb Res 2002; 1; 105(3):241-6.
  11. Siemens HJ, Brueckner S, Hagelberg S, Wagner T, Schmucker P. Course of molecular hemostatic markers during and after different surgical procedures. J Clin Anesth 1999; 11(8):622-9.
  12.  Bunescu A, Widman J, Lenkei R, Menyes P, Levin K, Egberg N. Increases in circulating levels of monocyte-platelet and neutrophil-platelet complexes following hip arthroplasty. Clin Sci 2002 Mar; 102(3):279-86.
  13. Schiffman FJ. Pathophysiology of blood. Translated from English. Moscow-St Petersburg: "Publishing BINOM" - "Nevsky Dialect", 2000. [in Russian].
  14. Fries D, Innerhofer P, Reif C, Streif W, Klingler A, Schobersberger W, et al. The effect of fibrinogen substitution on reversal of dilutional coagulopathy: an in vitro model. Anesth Analg 2006; 102(2):347-51.
  15. Carling MS, Jeppsson A, Wessberg P, Henriksson A, Baghaei F, Brisby H. Preoperative fibrinogen plasma concentration is associated with perioperative bleeding and transfusion requirements in scoliosis surgery. Spine 2011; 36 (7):549-555.
  16. Corradi A, Lazzaro F, Cofrancesco E, Cortellaro M, Ravasi F, Bertocchi F. Preoperative plasma levels of prothrombin fragment 1 + 2 correlate with the risk of venous thrombosis after elective hip replacement. Acta Orthop Belg 1999; 65(1):39-43.
  17. Chotanaphuthi T, Heebthamai D, Taweewuthisub W, Thiengwittayaporn S, Roschan S, Kanchanaroek K. Prediction of deep vein thrombosis after total knee arthroplasty with preoperative D-dimer plasma measurement. J Med Assoc Thai 2009; 92(6):6-10.

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Int J Biomed. 2012; 2(3):186-191. © 2012 International Medical Research and Development Corporation. All rights reserved.