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

Abstract

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.