In modern surgery, one main goal is to reduce perioperative and postoperative transfusion need.

The haemostatic disorders, the patients’ gender and the type of the operation seems to predict the blood loss in orthopaedic surgery.

It has been reported recently, an association of the Factor V Leiden mutation and with a lower rate of intra-partum blood loss,

Purpose: The aim of our study was to evaluate if there is an association between blood loss and pro c global system in orthopaedic operations.

Pro C Global system is influenced by FRO C, PRO S, APC resistance (FV Leiden) and FV111.

Materials and methods: We studied 42 patients, 31 women and 11 men, between 22–86 years old, who were operated in our hospital.

19 with total knee arthroplasty, 11 with total hip arthroplasty, 11 with fractures and 1 patient with amputation of -the lower leg.

The blood loss for each patient was calculated according the Mercurialli formula: Total blood loss: total blood volume x (Ht preop-Ht day 5 postop)+ml of RBC transfused. The total blood loss was expressed in terms of percentage of total blood volume and defined as relative blood loss.

Patients were divided into two groups with high and low relative blood loss, according the median value of the relative blood loss.

Pro C global values was monitored in all patients pre-operatively on a BCT analyzer (Dade Behring). Values > 0.8 are considered normal.

Results: The median value of relative blood loss was 15,05%. 21 patients were below this level and considered to have low relative blood loss. 21 patients were above this level and considered to have high relative blood loss. 18 patients had pro C Global values < 0.8 and 24 patients had Pro C Global > 0.8. Patients with low relative blood loss tend to show lower Pro C Global values than patients with high relative blood loss. (0,87 versus 0.90, p= 0.7 NS) without statistical difference.

Conclusions: In this study the Pro C global system does not seems to predict perioperative blood loss in patients with orthopaedic surgery and so it is useless to be monitored preoperatively.

It is known that patients who are undergoing major orthopaedic operations of the lower legs (fractures, total hip and knee arthroplasty) belong to a high-risk group, for the development of thromboembolic events.

20–40% of the patients develop deep vein thrombosis (DVT) of the calf and 2–4% fatal pulmonary embolism.

These patients may have remarkable activation of the coagulation system, which is important for the development of deep vein thrombosis of the lower legs.

Purpose: The aim of the study is to evaluate the activation of selected blood coagulation parameters, during the preoperative and postoperative period, in patients undergoing high risk of orthopaedic operation of lower limbs.

The exact estimation of these factors is necessary, so that these patients receive the suitable prophylactic antithrombotic therapy,

Patients and methods: We studied 24 patients, 16 women and 8 men, between 23–84 years old, 12 with femur fracture, 8 with total knee replacement and 4 with total hip replacement surgery.

All patients had normal renal function, and the platelets, count, the PT and aPTT were in a normal range.

The patients were hospitalized for 7 days and then they were observed as outpatients for the possibility of developing deep vein thrombosis and for a 4 weeks period.

All patients received a combination of LMWH and graduated compression elastic stockings as a prophylaxis against DVT.

Plasma concentration of Di-dimers and Thrombin -Antithrombin complex (TAT) were measured preoperatively and the second, the fourth and the sixth day postoperatively.

Di-dimers plasma concentration were measured by automated analyzer (VidasBiomerieux) and TAT plasma concentration were measured by an enzyme-linked microimmunoabsorbent assay (microelisa Dade-Berhing)

Results: Preoperative TAT concentration in patients with femur fracture were high. Postoperatively decreased with the major decreasement on the second day (p< 0.039). Till the 6th postoperative day TAT concentration remained above normal range. Di-dimers plasma concentrations were high preoperatively and remained also high postoperatively, without significant statistical difference.

In patients with total hip and knee arthroplasty TAT plasma concentration increased significantly the 12nd postoperative, day, decreased the 4th postoperative day and then increased again (p< 0.01). Di-dimers plasma concentration increased significantly the 2nd postoperative day and then decreased (p< 0,03).

Until the 6th postoperative day Di-dimcrs concentration remained above normal range. Patients with fractures had higher TAT levels preoperatively than patients with total hip and knee arthroplasty. (p< 0.027)

Conclusions: All patients with major orthopaedic surgery of lower limbs have shown significant activation of the coagulation system postoperatively. Patients with fractures present significant activation of the coagulation system post and preoperatively. So it may be necessary in patients with fractures, to start anticoagulation prophylaxis against DVT preoperatively, and the last dose of LMWH must be given 12 hours before the operation.