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.
Kudrnová
Zuzana
Z
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.
Kvasnička
Jan
J
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.
Kudrna
Karel
K
First Surgical Department of the General Teaching Hospital, 1st Medical School of Charles University, Prague, Czech Republic.
Mazoch
Jiří
J
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.
Malíková
Ivana
I
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.
Zenáhlíková
Zuzana
Z
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.
Sudrová
Magda
M
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.
Brzežková
Radka
R
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.
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