Favorable coagulation profile with fondaparinux after hip surgery in elderly patients.
Twenty-three patients with fondaparinux prophylaxis over 75 years of age who underwent hip fracture surgery were enrolled in the study. Fondaparinux sodium (2.5 mg) was administered subcutaneously 6 h postoperatively and then every 24 h for 28 days. Coagulation and inflammatory parameters were measured preoperatively, then 10 h, 2, 7, and 28 days postoperatively. Increased D-dimers, positive acute phase proteins, and IL-6, and decreased negative acute phase proteins were observed preoperatively (P < 0.05). Maximum values were reached 10 h postoperatively for IL-6 and D-dimer, and on postoperative days 2 and 7 for positive acute phase proteins (P < 0.05). Transferrin, prealbumin and antithrombin levels were lowest 10 h postoperatively and on postoperative day 2 (P < 0.05). Increased D-dimers, IL-6, and positive acute phase proteins, and decreased negative acute phase proteins persisted until postoperative day 28 (P < 0.05). Prothrombin fragments (F1 + 2) reached peak levels preoperatively and decreased gradually until postoperative day 28. Fondaparinux promoted the inhibition of thrombin generation, as documented by negative correlation between F1 + 2 and FXa inhibition (r = -0.46; P < 0.001). Fondaparinux-induced FXa inhibition increased gradually until postoperative day 28. This increase correlated positively with antithrombin activity (r = 0.4; P < 0.05). Fondaparinux prophylaxis counteracted pro-thrombogenic effect associated with hip fracture and subsequent surgery without severe bleeding complications.
Central Hematological Laboratory, Thrombotic Center of the General Teaching Hospital, 1st Medical School of Charles University, Karlovo náměstí 32, 128 08, Prague 2, Czech Republic. kudrnovaz@seznam.cz.
Zuzana
Z
Kudrnová
Central Hematological Laboratory, Thrombotic Center of the General Teaching Hospital, 1st Medical School of Charles University, Karlovo náměstí 32, 128 08, Prague 2, Czech Republic.
Jan
J
Kvasnička
First Surgical Department of the General Teaching Hospital, 1st Medical School of Charles University, Prague, Czech Republic.
Karel
K
Kudrna
Central Hematological Laboratory, Thrombotic Center of the General Teaching Hospital, 1st Medical School of Charles University, Karlovo náměstí 32, 128 08, Prague 2, Czech Republic.
Jiří
J
Mazoch
Central Hematological Laboratory, Thrombotic Center of the General Teaching Hospital, 1st Medical School of Charles University, Karlovo náměstí 32, 128 08, Prague 2, Czech Republic.
Ivana
I
Malíková
Central Hematological Laboratory, Thrombotic Center of the General Teaching Hospital, 1st Medical School of Charles University, Karlovo náměstí 32, 128 08, Prague 2, Czech Republic.
Zuzana
Z
Zenáhlíková
Central Hematological Laboratory, Thrombotic Center of the General Teaching Hospital, 1st Medical School of Charles University, Karlovo náměstí 32, 128 08, Prague 2, Czech Republic.
Magda
M
Sudrová
Central Hematological Laboratory, Thrombotic Center of the General Teaching Hospital, 1st Medical School of Charles University, Karlovo náměstí 32, 128 08, Prague 2, Czech Republic.
Radka
R
Brzežková
D000209:Acute-Phase Proteins / Q000032:analysis; D000368:Aged; D000369:Aged, 80 and over; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use*; D001777:Blood Coagulation / Q000187:drug effects*; D001780:Blood Coagulation Tests; D065427:Factor Xa Inhibitors; D005260:Female; D000077425:Fondaparinux; D006620:Hip Fractures / Q000097:blood / Q000601:surgery*; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007279:Injections, Subcutaneous; D008297:Male; D011134:Polysaccharides / Q000008:administration & dosage / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000517:prevention & control*; D013997:Time Factors; D054556:Venous Thromboembolism / Q000517:prevention & control*
D000209:Acute-Phase Proteins; D000925:Anticoagulants; D065427:Factor Xa Inhibitors; D018836:Inflammation Mediators; D011134:Polysaccharides; D000077425:Fondaparinux