Changes of the soluble fibrin monomer complex level during the perioperative period of hip replacement surgery.
BACKGROUND
Venous thromboembolism (VTE) is a critical complication after hip replacement surgery, so both early diagnosis and prophylaxis are important. The purpose of this study was to clarify the rapid changes of the fibrin monomer complex (FMC) and soluble fibrin (SF) during the perioperative period of hip replacement surgery.


METHODS
The subjects were 32 patients (7 men, 25 women) who underwent elective hip replacement surgery between November 2004 and January 2006. Their ages ranged between 34 to 82 years (mean 56.8 years). According to their thromboembolic risk, the patients received different prophylaxis: unfractionated heparin (4 patients), danaparoid sodium (14 patients), or mechanical therapy only (14 patients).


RESULTS
FMC and SF became rapidly elevated during the operation and just after surgery but declined to preoperational levels 3 days after surgery; they were higher in lupus anticoagulant (LA)-positive patients. In contrast, FDP and D-dimer had gradually become elevated 3 and 7 days after surgery. According to venous ultrasonography and lung perfusion scintigraphy, VTE occurred in 7 patients overall (21.9%). The incidence of VTE was 7.1% in the danaparoid group, whereas it was 35.7% in the mechanical therapy group. We also found that danaparoid sodium rapidly decreased FMC and SF within 3 days.


CONCLUSIONS
FMC and SF were rapidly elevated during hip replacement surgery and differentiated in LA-positive and LA-negative patients.
Department of Restorative Medicine of the Neuro-Musculoskeletal System, Graduate School of Medicine, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan.
Tomonori
T
Misaki
Isao
I
Kitajima
Tamon
T
Kabata
Mineko
M
Tani
Chiharu
C
Kabata
Tsunehisa
T
Tsubokawa
Hidesaku
H
Asakura
Katsuro
K
Tomita
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects; D002809:Chondroitin Sulfates / Q000627:therapeutic use; D003871:Dermatan Sulfate / Q000627:therapeutic use; D005260:Female; D005337:Fibrin / Q000032:analysis; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006493:Heparin / Q000627:therapeutic use; D006497:Heparan Sulfate / Q000627:therapeutic use; D006801:Humans; D007432:Intraoperative Period; D016682:Lupus Coagulation Inhibitor / Q000097:blood; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D054556:Venous Thromboembolism / Q000097:blood / Q000209:etiology / Q000517:prevention & control
D000925:Anticoagulants; D002809:Chondroitin Sulfates; D003871:Dermatan Sulfate; D005337:Fibrin; D005338:Fibrin Fibrinogen Degradation Products; D006493:Heparin; D006497:Heparan Sulfate; D016682:Lupus Coagulation Inhibitor; C036309:fibrin fragment D; C011468:fibrinmonomer; C035838:danaparoid