Platelet aggregation and coagulation factors in orthopedic surgery

Oberweis, Brandon S.; Cuff, Germaine; Rosenberg, Andrew D.; Pardo, Luis; Nardi, Michael A.; Guo, Yu; Dweck, Ezra; Marshall, Mitchell; Steiger, David; Stuchin, Steven A.; Berger, Jeffrey S.

doi:10.1007/s11239-014-1078-1

Cited by 15 publications

(17 citation statements)

References 33 publications

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“…Another advantage of these apparatuses, with the tests being performed on whole blood, is the capability to simultaneously study the interactions between platelets, cells and coagulation factors. Only a few studies have evaluated the use of thromboelastometry/graphy in patients undergoing MEOS [9][10][11][12][13][14][15]. However, none of them evaluated the determinants of significant bleeding.…”

Section: Introductionmentioning

confidence: 99%

Perioperative coagulation assessment of patients undergoing major elective orthopedic surgery

et al. 2016

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Traditional coagulative parameters are of limited use in identifying perioperative coagulopathy occurring in patients undergoing major elective orthopedic surgery (MEOS). The aim of our study was to evaluate the coagulation changes in patients undergoing MEOS and to facilitate an early detection of perioperative coagulopathy in patients experiencing major intraoperative bleeding. We enrolled 40 consecutive patients (M/F 10/30, age range 34-90 years) who underwent MEOS at the Orthopedic Unit of the Padua University Hospital, Italy, between January 2014 and January 2015. Blood samples were obtained at the following time points: T0-pre: 30 min before surgery; T0-post: 30 min after the end of the procedure; T1: morning of the first postoperative day; T2: 7 ± 2 days after surgery. Patients who experienced an intraoperative blood loss ≥250 mL/h were considered as cases. Routine coagulative parameters, thromboelastometry and thrombin generation (TG) profiles were evaluated. At baseline, a significantly lower platelet count and FIBTEM MCF/AUC were observed in patents with excessive bleeding (p < 0.05 and 0.02/0.01, respectively). At T0-post and T1 intervals, cases showed hypocoagulation characterized by a significantly low platelet count (p = 0.001), prolonged CFT INTEM/EXTEM, reduction of alpha-angle and MaxV INTEM/EXTEM, MCF and AUC INTEM/EXTEM/FIBTEM (p < 0.05 in all comparisons). The only TG parameter standing out between study groups was time to peak at T0-pre. A low platelet count and fibrinogen activity were associated with significant intraoperative bleeding in patients undergoing MEOS. Thromboelastometry performed by ROTEM(®) identifies patients with coagulopathy.

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Section: Introductionmentioning

confidence: 99%

Perioperative coagulation assessment of patients undergoing major elective orthopedic surgery

et al. 2016

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“…Endothelial dysfunction, microvascular coronary disease, aberrant inflammatory pathways, and heightened platelet activity may be contributing mechanisms. 22,23 …”

Section: Discussionmentioning

confidence: 99%

Relation of Perioperative Elevation of Troponin to Long-Term Mortality After Orthopedic Surgery

Oberweis¹,

Smilowitz²,

Nukala³

et al. 2015

The American Journal of Cardiology

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Background Myocardial necrosis in the perioperative period of non-cardiac surgery is associated with short-term mortality, but the effect on long-term outcomes has not been characterized. We investigated the association between perioperative troponin elevation and long-term mortality in a retrospective study of subjects undergoing major orthopedic surgery. Methods We performed a long-term follow-up study of consecutive subjects undergoing hip, knee, and spine surgery between November 1, 2008 and December 31, 2009. Patient demographics and comorbidities were ascertained using a hospital administrative dataset. Perioperative myocardial necrosis and ICD-9 coded myocardial infarction (MI) were recorded. Long-term survival was assessed using the Social Security Death Index (SSDI) database. Logistic regression models were used to identify independent predictors of long-term mortality. Results A total of 3,075 subjects underwent orthopedic surgery. Mean age was 60.7 years and a majority of subjects (59%) were female. Post-operative troponin was measured in 1060 (34.5%) subjects. Myocardial necrosis occurred in 179 (5.3%%) subjects and MI was coded in 20 (0.7%). Over 9,096 patient-years of follow up, 111 (3.6%) deaths occurred. Long-term mortality was 16.8% among subjects with myocardial necrosis, 5.8% with a troponin in the normal range, and 1.5% when a perioperative troponin was not measured. Perioperative troponin elevation (HR 2.33, CI 1.33 – 4.10) and coded post-operative MI (adjusted HR 3.51, CI 1.44 – 8.53) were significantly associated with long-term mortality after multivariable adjustment. Conclusions Post-operative myocardial necrosis is common following orthopedic surgery. Myocardial necrosis is independently associated with long-term mortality and may be used to identify subjects at higher risk for cardiovascular events who may benefit from aggressive management of cardiovascular risk factors.

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“…Increases in platelet aggregation and coagulation factor activities can be identified through 7 days after surgery. [85][86][87] Antiplatelet VTE prophylaxis with low-dose aspirin in human orthopedic patients was found to reduce the incidence of PE by 43% without an increased risk of major bleeding. 50 However, low-dose aspirin is associated with a 50% increase in upper gastrointestinal bleeding, a risk that is dose dependent and reduced with the concurrent administration of proton pump inhibitors.…”

Section: Surgery-specific Modificationsmentioning

confidence: 99%