title: Lowering blood glucose during hip surgery does not influence coagulation activation.
abstract: BACKGROUND
  Hyperglycaemia during and after hip surgery is associated with coagulation activation and an increased risk of venous thromboembolism. Whether lowering of glucose levels during hip surgery diminishes coagulation activation is unknown. We investigated the efficacy of the human GLP-1 analogue liraglutide to lower glucose during and after hip surgery and studied its influence on coagulation activation.
  
  
  METHODS
  A total of 37 obese subjects who underwent hip surgery were randomized to subcutaneous liraglutide or placebo for 4 consecutive days, starting one day prior to surgery. Glucose levels and coagulation indices at three fixed time-points (pre-operative, 2 h post-operative and 3 days post-operative) were measured.
  
  
  RESULTS
  Liraglutide reduced glucose at day three post-surgery (median glucose (IQR) liraglutide 5.5 (5.2-5.7) vs. placebo 5.8 (5.5-6.2); difference 0.3 mmol/L, P = 0.04). Changes in 6 out of 8 coagulation indices studied did not differ between the two groups. Only D-dimer levels were significantly lower in the liraglutide group at day three post-surgery and FVIII levels were significantly higher in the liraglutide group 2 h post-surgery.
  
  
  CONCLUSIONS
  Although the human GLP-1 analogue liraglutide moderately reduced post-operative blood glucose levels in non-diabetic and prediabetic obese patients undergoing elective hip surgery, no changes were observed with respect to coagulation activation.
authors.affiliation: Dept of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Marjolein K
authors.initials: MK
authors.lastname: Sechterberger
authors.affiliation: Dept of Anaesthesiology, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Jeroen
authors.initials: J
authors.lastname: Hermanides
authors.affiliation: Dept of Orthopaedic Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Rudolf W
authors.initials: RW
authors.lastname: Poolman
authors.affiliation: Dept of Anaesthesiology, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
authors.forename: Jasper E
authors.initials: JE
authors.lastname: Kal
authors.affiliation: Dept of Experimental Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands ; Dept of Plasma Proteins, Sanquin Research, Amsterdam, The Netherlands.
authors.forename: Joost C M
authors.initials: JC
authors.lastname: Meijers
authors.affiliation: Dept of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Joost B L
authors.initials: JB
authors.lastname: Hoekstra
authors.affiliation: Dept of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Hans DeVries
keywords: Blood coagulation; Glucagon-like peptide 1; Hyperglycaemia; Peri-operative period; Venous thromboembolism