Abstract PR518

Abstract

Background & Objectives: Hip replacement (HR) involves application of modern thromboprophylaxis schemes, which has reduced the rate of postoperative venous thromboembolism (VTE) to 1−9%. Consideration and modification of individual thrombogenic risk factors (TRFs) may be critical for further reducing the VTE rate. The study aim was to determine significance of the psycho-emotional state as one of TRFs in the period before HP in association with modern thromboprophylaxis schemes involving pharmacological and non-pharmacological modalities. Materials & Methods: The prospective, randomized, controlled study included 351 patients (156 (44.4%) males and 195 (55.6%) females). The patients were aged 30 to 74 years; body weight ranged from 54 to 158 kg. All patients were hospitalized for grade 2−3 coxarthrosis and, after randomization, were allocated into 3 groups, depending on the used anticoagulant: enoxaparin (156 patients), dabigatran etexilate (122 patients), and rivaroxaban (73 patients). To visualize venous thrombosis, ultrasound angiography of the lower limbs was used for the period of up to 3 months after surgery. Potential TRFs in the preoperative period were identified using a survey of patients, a study of medical records, and a number of laboratory tests. The psychological status was assessed using a subjective psychometric test, the Hospital Anxiety and Depression Scale (HADS). Results: A total of 7.1% VTE cases were identified. In 1 (0.3%) case, non-massive pulmonary embolism developed within the 1st postoperative day. With allowance for these data, 6 thrombogenic risk factors (out of 27 TRFs considered) were defined that significantly increased the risk of VTE: type 2 diabetes mellitus (odds ratio (OR) 5.6; 95% confidence interval (CI) 1.8−17.0), female gender (OR 4.6; CI 1.5−13.6), a low level of physical activity before surgery (OR 4.4; CI 1.7−11.1), age of 60 years or older (OR 4.3; CI 1.8−10.6), an elevated level of D-dimers (> 500 ng/mL) immediately before surgery (OR 3.5; CI 1.4−8.9), and varicose veins of the lower limbs (OR 3.4; CI 1.5−7.7). The clinical level of anxiety/depression (A/D) was ≥11 in general, did not demonstrate a statistically significant correlation with the development of VTE (OR 2.1; CI 0.9−4.9; p=0.37). However, the risk of VTE increased 4.1 times (CI 1.5−11.5; p=0.02) in the group of patients aged 60 years and older, while in the group of patients <60 years, the risk of these complications is increased only 0.7 times (CI 0,1-5,8; p = 1.00). Conclusion: Despite the use of recommended doses of anticoagulants, the identified TRFs enable detection of patients at high risk of VTE. In this case, the anxiety/depression level manifests as a TRF in old age.