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 1824 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.

Introduction: The goal of our study was to develop a risk-oriented algorithm for the combined use of hemostatics and anticoagulants in patients after total arthroplasty of the knee or hip joints to reduce the risk of thrombohemorrhagic complications. Materials and methods: We performed a retrospective study (n=253). In group (Gr.) 1, the time interval (TI) between the administration of hemostatic and anticoagulant prophylaxis was ≤17 hours (n=145; 57.31%), and in Gr. 2 – 18-24 hours (n=108; 42.68%). We analyzed the influence of different factors on the development of thrombosis and bleeding cases after the operation. Results and discussion: Thrombohemorrhagic complications were observed in 27 (10.67%) patients. Thrombosis in Gr. 1 was associated with the use of tranexamic acid, and were recorded 2.2 times more often than in Gr. 2 (p<0.05). The development of thrombosis in Gr. 1 was influenced by: class II obesity, type 2 diabetes mellitus, myocardial infarction, venous pathology, age of patients >75 years, for women – an initially low level of international normalized ratio, and activated partial thromboplastin time (APTT) (p<0.05). The development of bleeding in Gr. 1 was influenced by: age >75 years, among men and women – an increased preoperative level of APTT, for women – a decreased level of fibrinogen and platelets (p<0.05). Conclusion: To prevent thrombosis and bleeding after arthroplasty of large joints, the TI between the use of hemostatics and anticoagulants should be at least 18 hours, especially in patients with the above risk factors, in particular, when using tranexamic acid and low molecular weight heparins.

Background. Anticoagulant and haemostatic drugs are used to prevent thrombosis and bleeding after arthroplasty. Combined therapy with these divergent agents, especially in comorbid patients, is not regulated in relevant clinical guidelines and may lead to a reduced effi cacy.Objectives. Assessment of the effect of time interval (TI) in variant combined settings of haemostatic and anticoagulant drugs and concomitant pathology on the development of thrombohaemorrhagic complications after hip or knee arthroplasty.Мethods. In a retrospective study, we analysed patients’ somatic status, haemostatic and anticoagulant drug regimes and their combined impact on the development of thrombohaemorrhagic complications in early postoperative period.Results. We analysed 253 case histories with total replacement of main lower limb joints. Two cohorts were defi ned with respect to TI between haemostatic and anticoagulant drug applications. TI was 17 h or less (n = 145; 57.31%) in cohort 1 and 18–24 h (n = 108; 42.68%) — in cohort 2. A total of 29 drug combinations were tested. Thrombohaemorrhagic complications were observed in 27 (10.67%) patients, with 22 (81.48%) in cohort 1. Thromboses in regimes with tranexamic acid developed in cohort 1 (p = 0.038) at a 2.2-folds higher rate than in cohort 2 (p < 0.05). Thrombosis development was infl uenced by grade 2 obesity (relative risk = 8.75, p = 0.037), type 2 diabetes (relative risk = 21, p = 0.00001), myocardial infarction (relative risk = 16.875, p = 0.00002), venous pathology (relative risk = 8.1, p = 0.045) and the patient’s age over 75 (relative risk = 6.8, p = 0.029). Age over 75 years increased the risk of bleeding by a factor of 12 (relative risk = 12, p = 0.015).Conclusion. After main joint arthroplasty, differential measures to prevent thrombohaemorrhagic complications include a minimal 18-h TI between haemostatic and anticoagulant agent applications, especially in tranexamic acid regimes, and the consideration of concomitant risk factors, such as grade 2 obesity, type 2 diabetes, myocardial infarction in history, venous pathology and age over 75 years.

The article demonstrates the importance of observing the time interval between hemostatic and anticoagulant therapy for at least 18 hours, particularly when using tranexamic acid as a hemostatic drug. The developed complications of a thrombotic and hemorrhagic nature in the early postoperative period after knee and hip arthroplasty were analyzed. Schemes of hemostatic and anticoagulant agents, which developed thrombosis and hemorrhagic complications, were also determined.