Effect of Age on the Hemostatic Function in Patients with Degenerative Diseases of the Large Joints

Background: Aging is associated with an increased hypercoagulable state. Degenerative diseases of the large joints are also accompanied by increased coagulation activity. We investigated the effect of age on the hemostatic function in patients with osteoarthritis. Material and Methods: The study included 192 patients with osteoarthritis admitted to the clinic for primary hip or knee arthroplasty. The patients were categorized into 5 age groups: the age group under 40 years, the 41–to-50 -year age group, the 51–to-60-year age group, the 61-to-70- year age group, and the age group over 70 years. The general blood clotting tests, platelet number, fibrinogen, antithrombin, protein C, TAT, D-dimer, vonWillebrand factor (vWF), PAI-1, ß-thromboglobulin were determined. Results: Among patients with osteoarthritis, the antithrombin III level significantly decreased by the age of 50; however, above the age of 60 there was a distinct decrease in platelet count, and over the age of 70 the activity of the extrinsic coagulation pathway and the plasminogen level dropped significantly. TAT and D-dimer levels were elevated in most of the patients. Conclusion: The decrease in platelet count coupled with the activity of the extrinsic coagulation pathway in elderly osteoarthritic patients may increase blood loss during total arthroplasty; also, the drop in the anticoagulant and fibrinolytic potential may play a negative role in strengthening the prothrombotic state during the postoperative period

Soluble Thrombomodulin and Major Orthopedic Surgery

Abstract Background: A high level of soluble thrombomodulin (sTM) is associated with a lower risk of thrombosis but can cause severe bleeding after operations. Deep vein thrombosis (DVT) and blood loss are serious threats after orthopedic surgery. The aim of our pilot study was to evaluate the effect of the preoperative level of sTM on coagulation and inflammation as well as the blood loss and the development of symptomatic DVT after total large joint replacement. Methods and Results: In all patients (n=50) who underwent total hip or knee replacement, sTM, PrC, D-dimer, vWF, CRP, and platelets were determined before and after the operation. According to the preoperative sTM level, patients were divided into 2 groups: the thrombomodulin low (TML) group (n=25) and thrombomodulin high (TMH) group (n=25). The concentration of sTM was 4. 4 [3.4, 4.7] ng/ml in the Conclusion: These findings support the important role of sTM in coagulation, inflammation, bleeding, and presumably in venous thrombosis after major orthopedic surgery. (Int J Biomed. 2016;6(3):213-217.)

Effect of Preoperative Activation Hemostasis on the Dynamics of Coagulation and Fibrinolysis Post Large Joint Arthroplasty

The prediction and diagnosis of thromboembolic complications in extensive orthopedic surgery pose a serious problem. Solving this problem becomes important in the study of the functioning of the hemostatic system. The study of the functioning hemostatic system is important for solving this problem. We investigated the effect of the pre-operative activity of fibrin formation and fibrinolysis on the dynamics of hemostasis, post primary hip or knee arthroplasty. This prospective study included 102 patients, segregated into two groups: The 1st group of 51 patients was characterized by the preoperative activity of the formation of fibrin degradation products (D-dimer) in the normal range (<250ng/mL) with a mean value of 153±55 ng/mL; the 2nd group of 51 patients had an initial D-dimer concentration above the norm, with a mean value of 470±201 ng/mL. Otherwise, the groups were equal with respect to gender, localization of the operated segment, and type of anesthesia. This study was performed prior to surgery, and days 1, 3, 7, 14, post arthroplasty. The coagulation parameters, fibrinolysis, and physiological anticoagulants were determined. Patients of the 2nd group were older than the patients of the 1st group: 51.7±9.7 years vs. 57.0±10.7 years, p<0.05. In the 2nd group, patients with higher initial levels of fibrin formation and lysis, showed retention of higher D-dimer concentrations after day 1 post surgery (1,447±478 ng/mL vs 1,202±594 ng/mL in the 1st group, p<0.05) and after day 3, post surgery. However, by day 7, the differences were leveled. No significant differences in the TAT, plasminogen and PAI-1 levels were observed during the entire study. No significant differences were noted in the number of verified thromboses of the deep veins, which was 17.5% in the 1st group and 16.1% in the 2nd group. The initial increase in the degree of fibrin formation and fibrinolysis did not raise the risk of thromboembolic complications during hip and knee arthroplasty