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Thromb Haemost 1999; 81(06): 874-878
DOI: 10.1055/s-0037-1614591
Letters to the Editor
Schattauer GmbH

Procedure-dependence and Tissue Factor-independence of Hypercoagulability during Orthopaedic Surgery

S. Fedi
2   From Istituto di Clinica Medica Generale e Cardiologia, University of Florence, Italy
,
A. M. Gori
2   From Istituto di Clinica Medica Generale e Cardiologia, University of Florence, Italy
,
M. Falciani
2   From Istituto di Clinica Medica Generale e Cardiologia, University of Florence, Italy
,
A. P. Cellai
2   From Istituto di Clinica Medica Generale e Cardiologia, University of Florence, Italy
,
P. Aglietti
1   II Clinica Ortopedica, University of Florence, Florence, Italy
,
A. Baldini
1   II Clinica Ortopedica, University of Florence, Florence, Italy
,
L. M. Vena
1   II Clinica Ortopedica, University of Florence, Florence, Italy
,
D. Prisco
2   From Istituto di Clinica Medica Generale e Cardiologia, University of Florence, Italy
,
R. Abbate
2   From Istituto di Clinica Medica Generale e Cardiologia, University of Florence, Italy
,
G. F. Gensini
2   From Istituto di Clinica Medica Generale e Cardiologia, University of Florence, Italy
› Author Affiliations
Further Information

Publication History

Received 21 August 1998

Accepted after revision 11 March 1999

Publication Date:
09 December 2017 (online)

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Summary

The increased risk for deep vein thrombosis (DVT) after orthopaedic surgery has been well documented as well as hypercoagulable state during both total hip arthroplasty (THA) and total knee replacement (TKR). To investigate the influence of the surgical procedure [postero-lateral (PL) or lateral (L) approach for THA, use of tourniquet (TQ) or not use of TQ for TKR] on the hypercoagulability and the role of extrinsic pathway activation and endothelial stimulation during orthopaedic surgery we have examined 40 patients (20 patients undergoing primary THA – 10 with PL approach and 10 with L approach – and 20 patients undergoing TKR – 10 with TQ application and 10 without TQ). Thrombin-antithrombin complexes (TAT), tissue factor (TF), tissue factor pathway inhibitor (TFPI), thrombomodulin (TM) and von Willebrand factor antigen (vWF:Ag) were analyzed before and during the orthopaedic surgery. During THA, TAT plasma levels increased more markedly in patients assigned to the L than PL approach (p <0.05); during TKR an elevation of TAT of higher degree (p <0.05) was observed when TQ was not applicated. Blood clotting activation was significantly (p <0.001) more relevant during THA than TKR. No changes in TF and vWF:Ag plasma levels were observed in all patients undergoing THA and TKR. TFPI plasma levels significantly (p <0.05) decreased 1 h after the end of the THA in group PL and group L, whereas they remained unaffected in the two groups of patients undergoing TKR. Similarly TM plasma levels significantly decreased during THA, but not during TKR. In conclusion, these results show that: 1) the site of surgical procedures and the type of approach affect the degree of hypercoagulability, 2) the blood clotting activation takes place in the early phases of orthopaedic surgery, without signs of extrinsic pathway and endothelial activation.

 

  • References

  • 1 Sharrock NE, Go G, Harpel PC, Ranawat CS, Sculco TP, Salvati EA. Thrombogenesis during total hip arthroplasty. Clin Orthop and related Research 1995; 319: 16-27.
    PubMedSearch in Google Scholar
  • 2 Sharrock NE, Sculco TP, Ranawat CS, Maynard MJ, Harpel PC. Changes in circulatory indices of thrombosis and fibrinolysis during total knee arthroplasty performed under tourniquet. J Arthroplast 1995; 10: 523-8.
    CrossrefPubMedSearch in Google Scholar
  • 3 Eriksson BI, Eriksson E, Risberg B. Impaired fibrinolysis and postoperative thromboembolism in orthopaedic patients. Thromb Res 1991; 62: 55-64.
    CrossrefPubMedSearch in Google Scholar
  • 4 Haake DA, Berkman SA. Venous thromboembolic disease after hip surgery. Clin Orthop 1989; 242: 212-31.
    PubMedSearch in Google Scholar
  • 5 Nemerson Y. Tissue factor: Then and now. Thromb Haemost 1995; 7: 180-4.
    Thieme ConnectPubMedSearch in Google Scholar
  • 6 Novotny WF, Brown SG, Girard TJ, Miletich JP, Brose Jr GJ. Platelets secrete a coagulation inhibitor functionally and antigenically similar to the lipoprotein associated coagulation inhibitor. Blood 1988; 72: 2020-5.
    PubMedSearch in Google Scholar
  • 7 Werling RW, Zacharski LR, Kisiel W, Bajaj SP, Memole VA, Rosseau SM. Distribution of tissue factor pathway inhibitor in normal and malignant human tissues. Thromb Haemost 1993; 69: 366-9.
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Dittman WA, Majerus PW. Structure and function of thrombomodulin. A natural anticoagulant. Blood 1990; 75: 329-36.
    PubMedSearch in Google Scholar
  • 9 Aglietti P, Salvati EA. Via d"accesso Posterolaterale per protesi totale d"anca. GIOT 1988; VII (01) 283-293.
    PubMedSearch in Google Scholar
  • 10 Hardinge K. The direct lateral approach to the hip. J Bone and Joint Surg 1982; 64B: 17-19.
    PubMedSearch in Google Scholar
  • 11 Johnson R, Carmichael JHE, Almond HOA, Loyones RP. Deep venous thrombosis following Charnley arthroplasty. Clin Orthop 1978; 132: 24-30.
    PubMedSearch in Google Scholar
  • 12 Torholm C, Broeng L, Seest Jorgensen P, Bjerregaard P, Josephsen L, Hagen K, Bjerre Knudsen J. Thromboprophylaxis by low molecular-weight heparin in elective hip surgery. A placebo controlled study. J Bone Joint Surg 1991; 73: 434-8.
    PubMedSearch in Google Scholar
  • 13 Sharrock NE, Ranawat CS, Urquhart B, Mineo R, Peterson M. Factors influencing deep-vein thrombosis following total hip arthroplasty. Anesth Analg 1993; 76: 765-71.
    PubMedSearch in Google Scholar
  • 14 Demers C, Marcoux S, Ginsberg JS, Laroche F, Cloutier R, Poulin J. Incidence of venographically proved deep vein thrombosis after knee arthroscopy. Arch Intern Med 1998; 158: 47-50.
    CrossrefPubMedSearch in Google Scholar
  • 15 Abdel-Salam A, Eyres KS. Effects of tourniquet during total knee arthroplasty. A prospective randomized study. J Bone Joint Surg 1995; 77B: 250-3.
    PubMedSearch in Google Scholar
  • 16 Klenerman L, Biswas M, Hulands GH, Rhodes AM. Systemic and local effects of the application of a tourniquet. J Bone Joint Surg 1980; 62B: 385-87.
    PubMedSearch in Google Scholar
  • 17 Ruttmann TG, James MFM, Viljoen JF. Haemodilution induces a hyper-coagulable state. Br J Anaesth 1996; 76: 412-4.
    CrossrefPubMedSearch in Google Scholar
  • 18 Stalder M, Havert J, Kruithof EKO, Bachmann F. Release of vascular plasminogen activator (v-PA) after venous stasis: electrophoretic-zymo-graphic analysis of free and complexed v-PA. Ber J Haematol 1985; 61: 169-76.
    PubMedSearch in Google Scholar
  • 19 Cellai AP, Fedi S, Allessandrello Liotta A, Falciani M, Baldini A, Vena L, Rogolino A, Gori AM, Prisco D, Aglietti P, Abbate R. Activation of coagulation during primary total knee replacement with and without tourniquet. Thromb Res 1998; 91: S92.
    PubMedSearch in Google Scholar
  • 20 Rapaport SI. The extrinsic pathway inhibitor: a regulator of tissue factor-dependent blood coagulation. Thromb Haemost 1991; 66: 6-15.
    Thieme ConnectPubMedSearch in Google Scholar
  • 21 Sandset PM, Hogevold HE, Lyberg T, Andersson TR, Abildgaard U. Extrinsic pathway inhibitor in elective surgery: a comparison with other coagulation inhibitors. Thromb Haemost 1989; 62: 856-60.
    Thieme ConnectPubMedSearch in Google Scholar
  • 22 Ohkura N, Enjyoji K, Kamikubo Y, Kato H. A novel degradation pathway of tissue factor pathway inhibitor: incorporation into fibrin clot and degradation by thrombin. Blood 1997; 90: 1883-92.
    PubMedSearch in Google Scholar
  • 23 Falciani M, Gori AM, Fedi S, Chiarugi L, Simonetti I, Dabizzi RP, Prisco D, Pepe G, Abbate R, Gensini GF, Neri Serneri GG. Elevated tissue factor and tissue factor pathway inhibitor circulating levels in ischaemic heart disease. Thromb Haemost 1998; 79: 495-9.
    Thieme ConnectPubMedSearch in Google Scholar
  • 24 Bredbacka S, Andreen M, Blomback M, Wykman A. Activation of cascade system by hip arthroplasty. No differences between fixation with and without cement. Acta Orthop Scand 1987; 58: 231-5.
    CrossrefPubMedSearch in Google Scholar
  • 25 Donadoni R, Baele G, Devulder J, Rolly G. Coagulation and fibrinolytic parameters in patients undergoing total hip replacement: influence of anaesthesia technique. Acta Anaesthesiol Scand 1989; 33: 588-92.
    CrossrefPubMedSearch in Google Scholar
  • 26 Davis FM, McDermott E, Hickton C, Wells E, Heaton DC, Laurenson VG, Gillespie WJ, Foate J. Influence of spinal and general anaesthesia on haemostasis during total hip arthroplasty. Br J Anaesth 1987; 59: 561-71.
    CrossrefPubMedSearch in Google Scholar
  • 27 Quehenberger P, Loner U, Kapiotis S, Handler S, Schneider B, Huber J, Speiser W. Increased levels of activated factor VII and decreased plasma protein S activity and circulating thrombomodulin during use of oral contraceptives. Thromb Haemost 1996; 76: 729-34.
    Thieme ConnectPubMedSearch in Google Scholar
  • 28 Fareed J, Messmore I. Plasma thrombomodulin levels as predictor of hemorragic (and thrombotic) events in patients on long-term anticoagulant treatment. Circulation 1997; 95: 2765-8.
    PubMedSearch in Google Scholar
  • 29 Kapiotis S, Besemer J, Bevec D, Valent P, Bettelheim P, Lechner K, Speiser W. Interleukin-4 counteracts pyrogen-induced downregulation of thrombomodulin in cultured human vascular endothelial cells. Blood 1991; 78: 410-5.
    PubMedSearch in Google Scholar
  • 30 Cella G, Rampin E, Sbarai A, Meneghin C, Toffoli S, Girolami A. Exogenous heparin reduces soluble plasma thrombomodulin levels. Blood coagulation and Fibrinolysis 1997; 8: 365-6.
    CrossrefPubMedSearch in Google Scholar
  • 31 Nesheim M, Wang W, Boffa M, Negashima M, Morser J, Bajzar L. Thrombin, thrombomodulin and TAFI in the molecular link between coagulation and fibrinolysis. Thromb Haemost 1997; 78: 386-91.
    Thieme ConnectPubMedSearch in Google Scholar
  • 32 Sandset PM, Abildgaard U, Larsen ML. Heparin induces release of extrinsic pathway inhibitor (EPI). Thromb Res 1988; 50: 803-13.
    CrossrefPubMedSearch in Google Scholar