Complex analysis of coagulation tests in patients undergoing the combination of hemostatic and antithrombotic therapy following large joint arthroplasty

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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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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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Supplementary files

Supplementary Files Action
1.
Рис. 1. Динамика активированного частичного тромбопластинового времени (АЧТВ). Сплошной линией А обозначена динамика АЧТВ у женщин (n=190). Пунктирной линией Б обозначена динамика АЧТВ у мужчин (n=63)

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2.
Рис. 2. Динамика фибриногена (Фг). Сплошной линией А обозначена динамика Фг у женщин (n=190). Пунк­тирной линией Б обозначена динамика Фг у мужчин (n=63)

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3.
Рис. 3. Динамика международного нормализованного отношения (МНО). Сплошной линией А обозначена динамика МНО у женщин (n=190). Пунктирной линией Б обозначена динамика МНО у мужчин (n=63)

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4.
Рис. 4. Динамика протромбинового времени (ПВ). Сплошной линией А обозначена динамика ПВ у женщин (n=190). Пунктирной линией Б обозначена динамика ПВ у мужчин (n=63)

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5.
Рис. 5. Динамика тромбоцитов (Тц). Сплошной линией А обозначена динамика Тц у женщин (n=190). Пунктирной линией Б обозначена динамика Тц у мужчин (n=63)

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© 2020 Golovko L.S., Safronenko A.V., Gantsgorn E.V., Sukhorukova N.V., Maklyakov Y.S.

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