Prognostic value of hemostasis system indicators in patients with a traumatological profile when taking anticoagulants

Abstract

Objective. To assess the state of the hemostasis system and the risk of hemorrhagic complications in patients before and after hip replacement while taking anticoagulants. Patients and methods. The study included 85 patients, 46 women (average age 62.8 ± 8.95) and 39 men (average age 55.1 ± 14.3) who were in the Clinic of Traumatology and Orthopedics of the I.I. Mechnikov NWSMU for planned hip replacement. All patients received rivaroxaban or apixaban at doses specified by Russian Clinical Guidelines for the diagnosis, treatment and prevention of venous thromboembolic complications. Retrospectively, in the postoperative period, the patients were divided into 2 groups: group 1 — 78 patients (42 women and 36 men) who had no hemorrhagic complications after hip replacement, and group 2 — 7 patients (4 women and 3 men) who had hemorrhagic events in the form of hematoma in the wound area. All patients underwent laboratory tests before surgery, on the first day and on the 10th day after arthroplasty. The laboratory study included the determination of hemostasis parameters (PT in seconds, PT % activity, APTB, Fibrinogen, D-dimer), the concentration of rivaroxaban or apixaban in blood plasma, molecular genetic study of the polymorphism of the G(-455)A gene. Results. When assessing the traumatic factors of surgical intervention in patients with hemorrhagic complications, the volume of blood loss is significantly higher (p = 0,001) compared with cases of uncomplicated course. Minor hyperfibrinogenemia (Me 5,18 g/l) before surgery was detected in group 2 patients. A statistically significant increase in fibrinogen concentration (p = 0,006) occurred in patients on the background of surgery and is associated with traumatic factors of surgery. There was an increase in the concentration of fibrinogen and the level of D-dimer above the reference values on the 10th day after endoprosthesis, but no statistically significant differences were observed in both groups. The concentration of rivaroxaban in the blood was within the therapeutic interval throughout the entire observation period, and apixaban was higher than the therapeutic dose in the group of patients with complications on the 1st day after surgery, while thrombosis and bleeding were not found in patients. Conclusion. Hyperfibrinogenemia in patients in the preoperative period and after surgery may be an additional factor in the development of postoperative complications. Determination of the concentration of rivaroxaban and apixaban in blood plasma using an automatic chromogenic test allows you to evaluate their anticoagulant effect.