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,
Pro C Global system is influenced by FRO C, PRO S, APC resistance (FV Leiden) and FV111.
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.
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.
The exact estimation of these factors is necessary, so that these patients receive the suitable prophylactic antithrombotic therapy,
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)
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)