Clinical and pharmacological risk assessment for thrombohaemorrhagic complications after total lower limb arthroplasty

Author:

Golovko L. S.1ORCID,Safronenko A. V.1ORCID,Sukhorukova N. V.1ORCID,Gantsgorn E. V.1ORCID

Affiliation:

1. Rostov State Medical University

Abstract

Background. Anticoagulant and haemostatic drugs are used to prevent thrombosis and bleeding after arthroplasty. Combined therapy with these divergent agents, especially in comorbid patients, is not regulated in relevant clinical guidelines and may lead to a reduced effi cacy.Objectives. Assessment of the effect of time interval (TI) in variant combined settings of haemostatic and anticoagulant drugs and concomitant pathology on the development of thrombohaemorrhagic complications after hip or knee arthroplasty.Мethods. In a retrospective study, we analysed patients’ somatic status, haemostatic and anticoagulant drug regimes and their combined impact on the development of thrombohaemorrhagic complications in early postoperative period.Results. We analysed 253 case histories with total replacement of main lower limb joints. Two cohorts were defi ned with respect to TI between haemostatic and anticoagulant drug applications. TI was 17 h or less (n = 145; 57.31%) in cohort 1 and 18–24 h (n = 108; 42.68%) — in cohort 2. A total of 29 drug combinations were tested. Thrombohaemorrhagic complications were observed in 27 (10.67%) patients, with 22 (81.48%) in cohort 1. Thromboses in regimes with tranexamic acid developed in cohort 1 (p = 0.038) at a 2.2-folds higher rate than in cohort 2 (p < 0.05). Thrombosis development was infl uenced by grade 2 obesity (relative risk = 8.75, p = 0.037), type 2 diabetes (relative risk = 21, p = 0.00001), myocardial infarction (relative risk = 16.875, p = 0.00002), venous pathology (relative risk = 8.1, p = 0.045) and the patient’s age over 75 (relative risk = 6.8, p = 0.029). Age over 75 years increased the risk of bleeding by a factor of 12 (relative risk = 12, p = 0.015).Conclusion. After main joint arthroplasty, differential measures to prevent thrombohaemorrhagic complications include a minimal 18-h TI between haemostatic and anticoagulant agent applications, especially in tranexamic acid regimes, and the consideration of concomitant risk factors, such as grade 2 obesity, type 2 diabetes, myocardial infarction in history, venous pathology and age over 75 years.

Publisher

Kuban State Medical University

Subject

General Medicine

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3