Protein C, protein S, antithrombin III, and hyperfibrinogenemia in deep vein thrombosis (DVT) among patients who underwent high risk orthopaedic surgery

Abstract

Post operative DVT  is believed to be rare in Indonesia, and so is trombophilia. It is necessary to know  the incidence of postoperative DVT in Indonesia and thrombophlia profile (protein C, S, AT III deficiency and hyperfibrinogenemia) in DVT and non DVT patient who underwent orthopedic surgery involving the hip and knee (high risk surgery). A cross sectional study was conducted in 20 patients who underwent surgery  involving the hip (total hip replacement  and fixation of proximal femoral fracture) and knee (total knee replacement and fixation of  distal femoral fracture). Protein C, protein S, antithrombin III, and fibrinogen were examined in day 5 post operative, as well as with compression/Doppler USG between day 10 to 21 post operative, and confirmed by venography  if USG findings was positive. Post operative DVT were found in 5 of  20  patients (25%). Deficiency of protein C (P= 0.46) protein S (P= 0.81), antithrombin III (P= 0.46), and hyperfibrinogenemia (P= 0.0547) did not correlate to post operative DVT. However, hyperfibrinogenemia was found to be a risk factor to post operative DVT (attributable risk= 1). Other confounding factor such as diabetes mellitus (P= 1.0), obesity (P= 0.28), hypertention (P= 1.0), hypertrigliseridemia, and hypercholesterolemia did not correlate to post operative DVT. The study suggested  the existence of postoperative DVT cases  in Indonesia. Hyperfibrinogenemia is a risk factor to promote post operative DVT. Deep vein thrombosis  did not correlate to protein S, protein C, and antithrombin III deficiency. (Med J Indones 2004; 13: 24-30) Keywords: Thrombophilia, hip, knee, venography