Effect of preoperative platelet alpha-granules secretion on hemostasis and blood loss in large joint arthroplasty

Background. Currently, it was proven that the role of platelets is not limited to the formation of a clot that stops blood loss and provides vascular wall repair. The importance of determining the functional characteristics of platelets in patients who underwent traumatic surgery is beyond doubt. However, there are few studies on this subject.

Aim. To determine the effect of the preoperative platelet α-granules secretory activity on the coagulation parameters and blood loss in total hip arthroplasty (THA).Material and methods. The study included 58 patients admitted to the hospital for primary total hip arthroplasty. All patients were divided into 2 groups according to the preoperative plasma level of the specific platelet α-granules protein β-thromboglobulin (β-TG). The group with a low plasma level of β-thromboglobulin (<30 IU/ml) consisted of 30 patients, the group with a high level (≥30 IU/ml) — 28 patients. Blood sampling was carried out 1 day before the operation, 30 minutes after surgery, on the 1st, 3rd, 7th 14th days after the total hip arthroplasty. The platelet count, β-thromboglobulin, and D-dimer levels were determined. The plasma coagulation was examined by using thromboelastography. The volume of intraoperative blood loss was estimated by the gravimetric method, postoperative blood loss — by drainage volume. Statistical analysis was carried out by using the Friedman, Wilcoxon, Mann–Whitney tests, calculating Spearman's rank correlation coefficient. All calculations were performed using the Statistica 8.0 software.

Results. Before surgery, the group with a high level of β-thromboglobulin showed significantly higher levels of D-dimer than the group with low levels: 132 [73; 191] ng/ml and 79 [37; 123] ng/ml (p=0.024); and shorter R times (time to onset of clotting): 13.7 [11.5; 15.3] min and 15.5 [13.0; 18.1] min (p=0.048), respectively. The maximum β-thromboglobulin was observed at the end of the operation. The release of β-thromboglobulin was significantly more intense in the group with low levels of β-thromboglobulin than in the group with high levels: 35.6 [10.5; 78.0] IU/ml and 19.0 [0; 41.3] IU/ml, respectively (p=0.027). A relationship was found between β-thromboglobulin levels and D-dimer concentration early after surgery (30 minutes), Spearman's correlation coefficients for groups with low and high levels of β-thromboglobulin: r=0.57 and r=0.48, respectively (p <0.05 for both). Blood loss in the group with low β-thromboglobulin levels was significantly higher than in the group with high levels: 850 [550; 1050] ml and 600 [500; 850] ml, respectively (p <0.05).

Conclusion. In patients requiring total hip arthroplasty, an increase in the activity of platelet α-granules secretion is associated with an increase in the activity of fibrin formation and a shortening of reaction time to onset of clotting; during surgery, the secretory activity of platelets is directly related to the activity of coagulation and affects blood loss volume.