[Comparison of hemostatic markers under different techniques for anesthesia-analgesia in total hip or knee replacement].
OBJECTIVE
Surgery promotes a state of hypercoagulability, predisposing to the possibility of postoperative thromboembolic complications. Our aim was to determine whether certain combinations of techniques (neuraxial, intravenous or both) for anesthesia and analgesia might be associated with attenuation of the prethrombotic state following total hip or knee replacement.


METHODS
Prospective longitudinal study of 45 patients undergoing elective hip or knee prosthetic surgery. The patients were randomized to 3 groups to receive different anesthesia-analgesia combinations: spinal-intravenous, spinal-epidural, or general-intravenous. From induction until 36 hours after surgery, we recorded the postoperative time course of the following markers of coagulation and fibrinolysis: platelet count; fibrinogen level; activated partial thromboplastin time; international normalized ratio; and levels of prothrombin activation fragments 1 and 2, thrombin-antithrombin III complex, and D-dimer.


RESULTS
No statistically significant between-group differences were found in patient demographic, clinical, surgical or postoperative data. No symptomatic thromboembolic complications or deaths were recorded in the 30 days after surgery. Statistically significant differences were found in laboratory results for samples taken 36 hours after surgery. Patients who received spinal-epidural anesthesia and analgesia had lower levels of prothrombin activation fragments 1 and 2 and longer activated partial thromboplastin times than the group receiving the spinal-intravenous combination.


CONCLUSIONS
The anesthetic technique used during surgery did not affect hemostasis. However, continuous epidural analgesia in the postoperative recovery period attenuated some markers of hypercoagulability.
de la Fuente Tornero
E
E
Servicio de Anestesiología y Reanimación, Hospital General Universitario Gregorio Marañón, Madrid. eldela@sescam.jccm.es
Garutti Martínez
I
I
Gutiérrez Tonal
B
B
Rodríguez Huertas
A
A
Chana Rodríguez
F
F
Villanueva Martínez
M
M
Pascual Izquierdo
C
C
D000368:Aged; D000698:Analgesia / Q000379:methods*; D000758:Anesthesia / Q000379:methods*; D000990:Antithrombin III / Q000032:analysis; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D015415:Biomarkers / Q000097:blood*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis; D005340:Fibrinogen / Q000032:analysis; D006487:Hemostasis; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D010149:Postoperative Pain / Q000188:drug therapy; D010314:Partial Thromboplastin Time; D010447:Peptide Hydrolases / Q000032:analysis; D010976:Platelet Count; D011183:Postoperative Complications / Q000097:blood* / Q000453:epidemiology / Q000517:prevention & control; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors; D013923:Thromboembolism / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D019851:Thrombophilia / Q000097:blood* / Q000150:complications
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C046193:antithrombin III-protease complex; D000990:Antithrombin III; D005340:Fibrinogen; D010447:Peptide Hydrolases