title: Perioperative coagulation assessment of patients undergoing major elective orthopedic surgery.
abstract: Traditional coagulative parameters are of limited use in identifying perioperative coagulopathy occurring in patients undergoing major elective orthopedic surgery (MEOS). The aim of our study was to evaluate the coagulation changes in patients undergoing MEOS and to facilitate an early detection of perioperative coagulopathy in patients experiencing major intraoperative bleeding. We enrolled 40 consecutive patients (M/F 10/30, age range 34-90 years) who underwent MEOS at the Orthopedic Unit of the Padua University Hospital, Italy, between January 2014 and January 2015. Blood samples were obtained at the following time points: T0-pre: 30 min before surgery; T0-post: 30 min after the end of the procedure; T1: morning of the first postoperative day; T2: 7 ± 2 days after surgery. Patients who experienced an intraoperative blood loss ≥250 mL/h were considered as cases. Routine coagulative parameters, thromboelastometry and thrombin generation (TG) profiles were evaluated. At baseline, a significantly lower platelet count and FIBTEM MCF/AUC were observed in patents with excessive bleeding (p < 0.05 and 0.02/0.01, respectively). At T0-post and T1 intervals, cases showed hypocoagulation characterized by a significantly low platelet count (p = 0.001), prolonged CFT INTEM/EXTEM, reduction of alpha-angle and MaxV INTEM/EXTEM, MCF and AUC INTEM/EXTEM/FIBTEM (p < 0.05 in all comparisons). The only TG parameter standing out between study groups was time to peak at T0-pre. A low platelet count and fibrinogen activity were associated with significant intraoperative bleeding in patients undergoing MEOS. Thromboelastometry performed by ROTEM(®) identifies patients with coagulopathy.
authors.affiliation: Thrombotic and Hemorrhagic Unit, Department of Medicine, University of Padova, Via Ospedale Civile 105, 35100, Padua, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Spiezia
authors.affiliation: Anesthesiology and Intensive Care Unit, Department of Medicine, University of Padova, Padua, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Vasques
authors.affiliation: Anesthesiology and Intensive Care Unit, Department of Medicine, University of Padova, Padua, Italy.
authors.forename: Astrid
authors.initials: A
authors.lastname: Behr
authors.affiliation: Thrombotic and Hemorrhagic Unit, Department of Medicine, University of Padova, Via Ospedale Civile 105, 35100, Padua, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Campello
authors.affiliation: Thrombotic and Hemorrhagic Unit, Department of Medicine, University of Padova, Via Ospedale Civile 105, 35100, Padua, Italy.
authors.forename: Sara
authors.initials: S
authors.lastname: Maggiolo
authors.affiliation: Department of Orthopedics, University of Padova, Padua, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Berizzi
authors.affiliation: Thrombotic and Hemorrhagic Unit, Department of Medicine, University of Padova, Via Ospedale Civile 105, 35100, Padua, Italy.
authors.forename: Sabrina
authors.initials: S
authors.lastname: Gavasso
authors.affiliation: HaemaCon Ltd, Bromley, England, UK.
authors.forename: Barry
authors.initials: B
authors.lastname: Woodhams
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Thrombotic and Hemorrhagic Unit, Department of Medicine, University of Padova, Via Ospedale Civile 105, 35100, Padua, Italy. paolo.simioni@unipd.it.
authors.forename: Paolo
authors.initials: P
authors.lastname: Simioni
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001780:Blood Coagulation Tests / Q000379:methods* / Q000706:statistics & numerical data; D017558:Elective Surgical Procedures / Q000592:standards; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000592:standards*; D059035:Perioperative Period / Q000379:methods*; D013916:Thrombelastography / Q000379:methods / Q000706:statistics & numerical data
keywords: Clinical laboratory techniques; Hemostatic disorders; Orthopedic procedures; Perioperative period; Surgical blood loss