Prothrombin fragment 1+2 in urine as an indicator of sustained coagulation activation after total hip arthroplasty

Borris, Lars C.; Breindahl, Morten; Ryge, Camilla; Sommer, Helle Mølgaard; Lassen, Michael R.

doi:10.1016/j.thromres.2007.05.002

Cited by 14 publications

(20 citation statements)

References 16 publications

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“…Such a test would be particularly useful in patients undergoing THR, because these patients are at high risk of developing postoperative thromboembolic complications [3]. Based on the results of the present study, which confirm previously published findings [7], uF1 + 2 testing could be such a test. (2) 1 (2) *Patients could have more than one transfusion, and more than one type of transfusion.…”

Section: Discussionsupporting

confidence: 89%

“…Based on documentation provided by Dade-Behring, the following equation can be used to convert between the two kits: ELISA monoclonal = 0.265 · ELISA micro ) 29.4. Based on this equation, the proposed cut-off for symptomatic VTE of uF1 + 2 between 0.3 and 0.5 nmol L )1 from the previous study [7] will be equivalent to uF1 + 2 between 50 and 103 pmol L )1 in the present study.…”

Section: Laboratory Analyses and Urine Samplingmentioning

confidence: 76%

“…, was used in the present study in contrast to a previous study in which the micro Behring kit was used, which measures F1 + 2 in nmol L )1 [7]. These two kits have different response curves and can therefore not be compared directly.…”

Section: Laboratory Analyses and Urine Samplingmentioning

confidence: 99%

“…When more thrombin is generated, patients are at higher risk of experiencing a symptomatic vascular thrombotic complication. In these patients, uF1 + 2 levels have been shown to be significantly higher than in patients without such events [7]. When thrombin generation is reduced, postoperative hemostasis may be insufficient, and this may put some patients at a higher risk of bleeding.…”

Section: Introductionmentioning

confidence: 99%

“…The prothrombin fragment 1 + 2 is excreted in urine (uF1 + 2) and levels can be measured by enzyme-linked immunosorbent assay (ELISA). It has been shown that uF1 + 2 levels are increased for several days after THR, an effect likely due to the activation of coagulation and subsequent thrombin generation because of surgical trauma [7]. When more thrombin is generated, patients are at higher risk of experiencing a symptomatic vascular thrombotic complication.…”

Section: Introductionmentioning

confidence: 99%

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Differences in urinary prothrombin fragment 1 + 2 levels after total hip replacement in relation to venous thromboembolism and bleeding events

Borris

Breindahl²,

Lassen

et al. 2008

Journal of Thrombosis and Haemostasis

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To cite this article: Borris LC, Breindahl M, Lassen MR, Pap AF, Misselwitz F. Differences in urinary prothrombin fragment 1 + 2 levels after total hip replacement in relation to venous thromboembolism and bleeding events. J Thromb Haemost 2008; 6: 1671-9.Summary. Background: Prothrombin fragment 1 + 2 is excreted in urine (uF1 + 2) as a result of thrombin generation and, therefore, may be a useful marker of coagulation status. Objectives: To assess uF1 + 2 levels after total hip replacement (THR) in patients with venous thromboembolism (VTE) and bleeding events. Patients/methods: This study was conducted in parallel with a prospective, dose-finding study evaluating the efficacy and safety of different doses of rivaroxaban (Xarelto Ò , Bayer HealthCare AG, Wuppertal, Germany) for thromboprophylaxis, relative to enoxaparin. Deep vein thrombosis was diagnosed by mandatory venography performed 5-9 days after THR, or earlier if symptomatic. Symptomatic pulmonary embolism was diagnosed by objective testing. Bleeding complications were registered and stratified into major bleeding, clinically relevant, non-major bleeding, and minor bleeding, using predefined criteria. Results: Eighty-four patients had a VTE and 57 patients had a bleeding event (n = 722). Significantly higher median uF1 + 2 levels were observed in the VTE group on day 3 after THR (P = 0.03), compared with control. Median uF1 + 2 levels were lower in the bleeding group on day 3 after THR (P = 0.005) and on the day of venography (P = 0.36), compared with control. Comparisons between the VTE and bleeding groups showed significantly lower median uF1 + 2 levels in the bleeding group on day 3 after THR and on the day of venography (P < 0.0001 and P = 0.006, respectively). Conclusions: Measurement of uF1 + 2 could provide a simple clinical test to evaluate noninvasively the intensity of coagulation activation after THR. However, further studies are required to confirm these encouraging preliminary results.

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Section: Discussionsupporting

confidence: 89%

Section: Laboratory Analyses and Urine Samplingmentioning

confidence: 76%

Section: Laboratory Analyses and Urine Samplingmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Differences in urinary prothrombin fragment 1 + 2 levels after total hip replacement in relation to venous thromboembolism and bleeding events

Borris

Breindahl²,

Lassen

et al. 2008

Journal of Thrombosis and Haemostasis

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Venous Thromboembolism Associated with Foot and Ankle Surgery

Malay

2017

Complications in Foot and Ankle Surgery

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Barriers to the optimal use of anticoagulants after orthopaedic surgery

Borris

2008

Arch Orthop Trauma Surg

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Venous thromboembolism (VTE) and the consequent morbidity and mortality associated with this condition continue to be a problem following orthopaedic surgery. The vast majority of patients undergoing orthopaedic surgery receive some form of thromboprophylaxis. However, the use of inappropriate thromboprophylaxis is an important factor which may explain why the clinical burden of VTE is still considerable. Barriers to the use of appropriate thromboprophylaxis include the belief by some surgeons that pharmacological thromboprophylaxis increases the risk of bleeding and the asymptomatic nature of deep vein thrombosis. In addition, in patients at risk of VTE, thromboprophylaxis should be given beyond the standard duration recommended in international or national guidelines, and many surgeons have concerns about adherence and adverse events in the outpatient setting. Furthermore, currently available anticoagulants have drawbacks, including the need for monitoring, or a subcutaneous route of administration. The introduction and implementation of multi-faceted and integrated approaches to thromboprophylaxis could improve adherence with current guidelines, extend appropriate thromboprophylaxis according to risk factors, and improve patient outcomes in this setting. In addition, the development of new anticoagulants with more convenient administration regimens and no need for monitoring may help to achieve these objectives.

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Prothrombin fragment 1+2 in urine as an indicator of sustained coagulation activation after total hip arthroplasty

Cited by 14 publications

References 16 publications

Differences in urinary prothrombin fragment 1 + 2 levels after total hip replacement in relation to venous thromboembolism and bleeding events

Differences in urinary prothrombin fragment 1 + 2 levels after total hip replacement in relation to venous thromboembolism and bleeding events

Venous Thromboembolism Associated with Foot and Ankle Surgery

Barriers to the optimal use of anticoagulants after orthopaedic surgery

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