Thrombosis markers in hip versus knee arthroplasty: a pilot study.
OBJECTIVE
To compare the thrombosis markers for thrombosis and fibrinolysis in patients undergoing hip versus knee arthroplasty.


METHODS
Seven women aged 38 to 61 years who underwent total hip arthroplasty (THA) and 7 women aged 57 to 67 years who underwent total knee arthroplasty (TKA) were studied. Thromboprophylaxis was given before and after surgery. In patients undergoing TKA, an automatic pneumatic tourniquet was used. Blood samples were drawn (1) before surgery (control value), (2) at wound closure (immediately before release of the tourniquet in TKA), and (3) 4 hours after surgery. Thrombosis markers (prothrombin fragment 1.2 [F1.2], plasmin/ alpha2-antiplasmin complex [PAP], and D-dimer) of the 2 groups were compared.


RESULTS
The F1.2 level increased significantly at wound closure and remained elevated 4 hours after surgery in the THA group, whereas it was unchanged at wound closure but increased significantly 4 hours after surgery in the TKA group. The PAP level was constant peri- and post-operatively in the THA group, whereas it increased significantly 4 hours after surgery in the TKA group. The D-dimer level increased significantly at wound closure and 4 hours after surgery in the THA group, whereas it was unchanged at wound closure but increased significantly 4 hours after surgery in the TKA group.


CONCLUSIONS
Systemic thrombin generation starts perioperatively in THA and after tourniquet deflation in TKA, indicating that wound blood must reach the systemic circulation to activate the relevant mediators.
Reikeras
Olav
O
Department of Orthopaedics, Rikshospitalet University Clinic, University of Oslo, Norway. olav.reikeras@rikshospitalet.no
Clementsen
Torkil
T
D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D015415:Biomarkers / Q000097:blood*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005341:Fibrinolysin / Q000378:metabolism; D006801:Humans; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D010865:Pilot Projects; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control*; D011516:Prothrombin; D018709:Statistics, Nonparametric; D013927:Thrombosis / Q000097:blood / Q000517:prevention & control*; D014111:Tourniquets; D000979:alpha-2-Antiplasmin / Q000378:metabolism
D000925:Anticoagulants; D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; D010446:Peptide Fragments; D000979:alpha-2-Antiplasmin; C036309:fibrin fragment D; C037742:plasmin-plasmin inhibitor complex; C045879:prothrombin fragment 1.2; D011516:Prothrombin; D005341:Fibrinolysin