Changes in blood coagulation in middle-aged and elderly patients with fresh vertebral compression fractures

Abstract

Objective To explore the short-term effects of fresh vertebral compression fracture on blood coagulation in middle-aged and elderly osteoporotic patients. Methods A retrospective analysis was conducted of the 140 middle-aged and elderly patients (70 ones with fresh vertebral compression fracture and 70 ones with degenerative spinal disease) who had been treated at Department of Orthopaedics, The First Affiliated Hospital to Peking University between January 2016 and December 2018. Collected were their baseline parameters including age, gender and American Society of Anesthesiologists (ASA) scores, preoperative blood parameters including coagulation indicators [D-Dimer, fibrinogen degradation product (FDP), prothrombin time (PT), activated partial thromboplastin time (APTT), fibrinogen (FIB), international normalized ratio (INR) and thrombin time (TT)] and platelets indicators, and fracture parameters including number of fractured vertebrae and duration of fracture. The 2 patients groups were divided into 5 age groups: 4 age groups for each 10 between 50 and 90 years and one age group for >90 years. The values of D-Dimer and FDP were compared between the 2 patient groups in each corresponding age group. The proportions of patients with D-Dimer negative and correlations between coagulation parameters and platelets before and after age adjustment were statistically analyzed. Results There were no statistically significant differences in the baseline parameters between the 2 patient groups(P>0.05). The mean onset time for the fracture group was 6.7 days. The values of D-Dimer, FDP, PT, INR, TT and FIB in the fracture group were significantly higher than those in the degenerative disease group(P<0.001). After the D-Dimer threshold adjusted by age, 75.71%(53/70) of the patients in the fracture group were negative while 98.57%(69/70) of those in the degenerative disease group were negative. Meanwhile, the values of D-Dimer and FDP showed a significant correlation (P<0.001) with a Pearson correlation coefficient of 0.932. Compared with the degenerative disease group, the values of D-Dimer and FDP in the fracture group increased significantly in the age groups from 61 to 90 years(P< 0.001). Conclusions Fresh vertebral compression fractures may have a significant effect on the blood coagulation in osteoporotic patients. It is therefore presumed that the middle-aged and elderly patients with fresh vertebral compression fracture may face a higher risk of deep vein thrombosis than those with degenerative spinal disease. Key words: Osteoporosis; Aged; Spinal fractures; Blood coagulation; Deep vein thrombosis; D-Dimer