Hidden Blood Loss After Total Knee Arthroplasty With Complex Tromboprophylaxis

Nakopiya, V.B.; Kornilov, N.N.; Божкова, С. А.; Kazemirskiy, A.V.; Goncharov, M. Yu.

doi:10.17513/spno.27272

Cited by 7 publications

(2 citation statements)

References 2 publications

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“…Такое грозное осложнение, как тромбоэмболия легочной артерии, может развиться у 0,9-28% пациентов, причем в 0,1-2% случаев она может завершиться летальным исходом [6,7]. Также стоит отметить, что эндопротезирование может осложниться кровотечениями различной степени тяжести и объем кровопотери может составлять 20-40% от объема циркулирующей крови [8]. При эндопротезировании коленного сустава кровопотеря может составить 570-2500 мл [9], а при подобных операциях на тазобедренном суставе -около 670-1040 мл [10].…”

Section: Introductionunclassified

Thrombosis and bleeding after endoprosthetics of large joints of the lower extremities: what can increase the risk of thrombohemorrhagic complications?

Головко¹,

Сафроненко²,

Gantsgorn³

2020

jour

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Objective: to assess the effect of the baseline hemostasiogram and comorbid background on the development of thrombosis and bleeding in the early postoperative period in patients receiving combined hemostatic and anticoagulant pharmacoprophylaxis after arthroplasty of the knee and hip joints.Materials and Methods: A retrospective analysis of 253 case histories of patients with hip or knee arthroplasty performed. The patients received combined pharmacoprophylaxis with hemostatics and anticoagulants. Two groups were identified according to the time interval (TI) between the appointment of hemostatic and anticoagulant drugs. The first group (57,31%) - n=145 (112 women and 33 men), TI≤17 h, the second group (42,68%) — n=108 (78 women and 30 men), TI 18-24 h. In patients, we analyzed the effect of comorbidity and baseline values of the coagulogram on the risk of thrombosis or bleeding in the early postoperative period.Results: Thrombohemorrhagic complications were registered in 27 (10,67%) patients, of which 22 (81,48%) were in the first group. Thrombosis in the first group developed in the regimens with tranexamic acid (p=0,038), and their frequency was 2,2 times higher than in the second group (p=0,023). In the first group, the risk of thrombosis in women was increased by the initially low level of international normalized ratio (INR) (relative risk (RR)=13,333, p=0,00032) and activated partial thromboplastin time (APTT) (RR=5,8, p=0,037). The risk of bleeding in the first group among men and women increased with an increased preoperative APTT level (RR=18, p=0,0012 and RR=28, p=0,00022, respectively), and separately for women - with a reduced content of fibrinogen (RR=23,25, p=0,00065) and platelets (RR=10,2, p=0,038). The development of thrombosis as influenced by: degree 2 obesity (RR=8,75, p=0,037), type 2 diabetes mellitus (RR=21, p=0,00001), myocardial infarction (RR=16,875, p=0,00002), venous pathology (RR=8,1, p=0,045), moderate decline in renal function (RR=6,231, p=0,0465) and age over 75 years (RR=6,8, p=0,029). Age over 75 years increased the risk of bleeding 12-fold (RR=12, p=0,015).Conclusions: to minimize the risk of thrombosis and bleeding after endoprosthetics of large joints of the lower extremities, especially in patients with the above risk factors, in particular, when using tranexamic acid as a hemostatic, it is recommended to observe the TI between hemostatic and anticoagulant pharmacoprophylaxis of at least 18 hours.

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Section: Introductionunclassified

Thrombosis and bleeding after endoprosthetics of large joints of the lower extremities: what can increase the risk of thrombohemorrhagic complications?

Головко¹,

Сафроненко²,

Gantsgorn³

2020

jour

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show abstract

“…Кроме этого, тотальное эндопротезирование крупных суставов может осложниться кровотечениями различной степени тяжести, причём объём кровопотери может достигать 20-40% объёма циркулирующей крови. Для фармакологической коррекции геморрагических осложнений пациенту показано назначение гемостатических лекарственных средств (ЛС) [9].…”

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

et al. 2020

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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.

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Causes of unsatisfactory results of arthroplasty of the knee joint osteoarthritis in long-term postoperative period: literature review

Ткаченко

Dulaev²,

Spichko³

et al. 2023

N.N. Priorov Journal of Traumatology and Orthopedics

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In Russia and globally, total knee arthroplasty (TKA) has been increasingly performed. The high quality of implants, improvement of arthroplasty technologies, and accumulated practical experiences of surgeons did not considerably reduce the frequency of complications and unsatisfactory operative outcomes. The negative consequences of knee replacement are determined both intraoperatively and postoperatively. This review aimed to analyze the literature on the frequency and complications of knee arthroplasty and their causes in the long-term postoperative period. In recent decades, the number of patients who are not satisfied with TKA outcomes has been increasing. Moreover, information about complications, their frequency, their causes, and possibilities of preventing negative consequences remains contradictory. Surgical treatment of complications requires particular attention, with surgical site infections as the most common. Recent studies highlight the important of evaluating surgical site infections during and after TKA, especially for deep infectious complications after TKA, which leads to hospitalizations, and reoperations. To date, many studies have investigated early postoperative complications leading to negative consequences in the long-term postoperative period. In addition, in the absence of postoperative complications, the service life of the implant is limited, and unsatisfactory TKA outcomes were attributed to wear and tear of the endoprosthesis. Domestic and international studies about premature or unreasonable TKA, as one of the reasons for negative osteoarthritis treatment outcomes, are increasing. The discussion about the indications and contraindications for knee arthroplasty continues. This literature review discusses the current state of this topic.

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Hidden Blood Loss After Total Knee Arthroplasty With Complex Tromboprophylaxis

Cited by 7 publications

References 2 publications

Thrombosis and bleeding after endoprosthetics of large joints of the lower extremities: what can increase the risk of thrombohemorrhagic complications?

Thrombosis and bleeding after endoprosthetics of large joints of the lower extremities: what can increase the risk of thrombohemorrhagic complications?

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

Causes of unsatisfactory results of arthroplasty of the knee joint osteoarthritis in long-term postoperative period: literature review

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