Editorial Commentary: Doctor, Will My Contralateral Hip Surgery Go as Well as the First One?

SummaryWe evaluated the evidence in support of the suggestion that the risk of deep vein thrombosis after hip surgery is lower with regional than with general anesthesia. A literature search was performed to retrieve all articles which reported on the incidence of postoperative thrombosis in both fractured and elective hip surgery. Articles were included if the method of anesthesia used was reported and if they used mandatory venography. Based upon the quality of study design the level of evidence provided by a study was graded.In patients who did not receive prophylaxis there were high level studies in elective and fractured hip surgery. All studies showed a statistically significantly lower incidence of postoperative deep vein thrombosis with regional anesthesia (relative risk reductions of 46-55%). There were no direct comparative studies in patients who received prophylaxis. However, between study comparisons did not show even a trend towards to lower incidence of postoperative thrombosis with regional anesthesia.

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Extrinsic Pathway Inhibitor in Elective Surgery: A Comparison with other Coagulation Inhibitors

Thrombosis and Haemostasis ◽

10.1055/s-0038-1651017 ◽

1989 ◽

Vol 62 (03) ◽

pp. 856-860 ◽

Cited By ~ 28

Author(s):

P M Sandset ◽

H E Høgevold ◽

T Lyberg ◽

T R Andersson ◽

U Abildgaard

Keyword(s):

Vascular Surgery ◽

Protein C ◽

Elective Surgery ◽

Perioperative Period ◽

Acute Phase Reactant ◽

Hip Surgery ◽

Albumin Concentration ◽

Extrinsic Pathway ◽

Heparin Cofactor Ii ◽

Coagulation Inhibitors

SummaryExtrinsic coagulation pathway inhibitor may be an important regulator of haemostasis to prevent thrombosis after tissue damage. The functional activity of this inhibitor was determined using a chromogenic substrate assay, and compared to the activities of anti thrombin, heparin cofactor II and protein C during the perioperative period of elective hip replacement (n = 28), cholecystectomy (n = 11), and vascular surgery (n = 5). Peroperatively, all the inhibitors decreased rather similarly and to the same degree as the decrease in albumin concentration. The decreases during hip surgery were about 2-fold the decreases observed during cholecystectomy. A significant peroperative increase in extrinsic pathway inhibitor activity was observed in vascular surgery, probably due to a bolus injection of heparin. Antithrombin, heparin cofactor II and protein C levels normalized on days 3-5 postoperatively in all three patient groups. Sustained low levels of extrinsic pathway inhibitor were observed on postoperative days 1 to 7 in hip surgery patients. Apparently, extrinsic pathway inhibitor is not an acute phase reactant. In uncomplicated surgery, the decreases of the coagulation inhibitor levels are mainly due to hemodilution.

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