title: Increased fibrinolysis increases bleeding in orthopedic patients receiving prophylactic fondaparinux.
abstract: We evaluated hemostatic markers in patients who underwent major orthopedic surgery, including total hip and total knee arthroplasty, and were treated for the prophylaxis of deep vein thrombosis (DVT) with or without fondaparinux (anti-Xa group, n = 98 and without anti-Xa group, n = 20). The frequency of DVT was significantly higher in the without anti-Xa group than in the anti-Xa group, but the reduction of hemoglobin and fibrinolytic marker levels was significantly lower in the without anti-Xa group than in the anti-Xa group. Eighteen patients in the anti-Xa group showed a reduction in hemoglobin of more than 2 g/dl, and those individuals were considered to be the increased bleeding (IB) group. The concentration of fibrinolytic markers in the anti-Xa group was significantly higher in the IB group than in the non-IB group. There were also no significant differences in the levels of anti-Xa activity, plasminogen activator inhibitor-I, soluble fibrin and antithrombin between the IB and non-IB groups. In conclusion, elevated fibrinolysis induced by increased bleeding may lead to further increases in bleeding in patients receiving thromboprophylaxis with fondaparinux following major orthopedic surgery.
authors.affiliation: Department of Orthopaedic Surgery, Mie University Graduate School of Medicine, Tsu, Japan.
authors.forename: Kakunoshin
authors.initials: K
authors.lastname: Yoshida
authors.forename: Hideo
authors.initials: H
authors.lastname: Wada
authors.forename: Masahiro
authors.initials: M
authors.lastname: Hasegawa
authors.forename: Hiroki
authors.initials: H
authors.lastname: Wakabayashi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Matsumoto
authors.forename: Yuji
authors.initials: Y
authors.lastname: Shimokariya
authors.forename: Katsura
authors.initials: K
authors.lastname: Noma
authors.forename: Norikazu
authors.initials: N
authors.lastname: Yamada
authors.forename: Atsumasa
authors.initials: A
authors.lastname: Uchida
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Nobori
authors.forename: Akihiro
authors.initials: A
authors.lastname: Sudo
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000009:adverse effects*; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D015415:Biomarkers / Q000097:blood; D065427:Factor Xa Inhibitors; D005260:Female; D005337:Fibrin / Q000378:metabolism; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005340:Fibrinogen / Q000378:metabolism; D005342:Fibrinolysis / Q000187:drug effects* / Q000502:physiology; D000077425:Fondaparinux; D006470:Hemorrhage / Q000097:blood / Q000139:chemically induced*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides / Q000008:administration & dosage / Q000009:adverse effects*; D011183:Postoperative Complications / Q000097:blood / Q000517:prevention & control; D020246:Venous Thrombosis / Q000097:blood / Q000517:prevention & control*
chemical_list: D000925:Anticoagulants; D015415:Biomarkers; D065427:Factor Xa Inhibitors; D005338:Fibrin Fibrinogen Degradation Products; D011134:Polysaccharides; C036309:fibrin fragment D; D005337:Fibrin; D005340:Fibrinogen; D000077425:Fondaparinux