Alterations in Plasma Antithrombin III Following Total Hip Replacement and Elective Cholecystectomy

2009 ◽  
Vol 24 (2) ◽  
pp. 101-104 ◽  
Author(s):  
Kaj Anker Jørgensen ◽  
Erik Stoffersen ◽  
Per J. Sørensen ◽  
Steen Ingeberg ◽  
Mogens Hüttel ◽  
...  
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Antithrombin Iii ◽  
Total Hip ◽  
Elective Cholecystectomy

Effects on Coagulation and Fibrinolysis of Desmopressin in Patients Undergoing Total Hip Replacement

1991 ◽  
Vol 66 (06) ◽  
pp. 652-656 ◽  
Author(s):  
Per Anders Flordal ◽  
Karl-Gösta Ljungström ◽  
Jan Svensson ◽  
Brenda Ekman ◽  
Gustaf Neander
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Bleeding Time ◽  
Antithrombin Iii ◽  
Postoperative Bleeding ◽  
Double Blind ◽  
Total Hip ◽  
Von Willebrand ◽  
Willebrand Factor ◽  
Coagulation And Fibrinolysis

SummaryTwelve patients undergoing total hip replacement, with regional anaesthesia and with dextran infusion for plasma expansion and thromboprophylaxis, were given the vasopressin analogue desmopressin (DDAVP) or placebo in a randomized, double-blind prospective study. In controls (n = 6) we found a prolongation of the bleeding time, low factor VIII (FVIII) and von Willebrand factor (vWF) and a decrease in antithrombin III to levels known to be at risk for venous thrombosis. Desmopressin shortened postoperative bleeding time, gave an early FVIII/vWF complex increase, prevented antithrombin III from falling to critically low values and appeared to activate the fibrinolytic system, both by tPA increase and PAI-1 decrease.Thus in the controls we found changes in both coagulation and fibrinolysis indicating a haemorrhagic diathesis as well as a risk for thromboembolism. Desmopressin induced factor changes that possibly reduce both risks.

Changes In Biologically And Immunochemically Measured Antithrombin III (At III) In Total HIP Replacement With Special Regard To Type Of Thromboembolic Prophylaxis

1981 ◽  
Author(s):  
H O Fredin ◽  
L Tengborn
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Antithrombin Iii ◽  
Screening Method ◽  
Chromogenic Substrate ◽  
Thromboembolic Prophylaxis ◽  
Total Hip ◽  
At Iii ◽  
Lung Scanning

The plasma levels of AT III were studied in 71 patients operated with total hip replacement. AT III was determined with amidolytic assay using the chromogenic substrate Coatest S-2238 (KabiDiagnostica, Sweden) as well as electroimmunochemically. Samples were drawn before the operation and 4-5 times the first week postoperatively. The results were adjusted to the hematocrit (Hcr) for each sample.The patients were randomly allocated to thromboprophylactic prevention with either Macrodex (Pharmacia, Sweden) or heparin with dihydroergotamine (Sandoz, Switzerland). Phlebography of the operated leg and perfusion/ventilation lung scanning was performed on the 10-14th postoperative day.Results. No difference in the AT III levels were seen in patients who developed postoperatively deep venous thrombosis and/or pulmonary embolism (DVT/PE) as compared to those who did not develop DVT/PE.No decrease of AT III was found postoperatively, when adjusted to HcrThe frequency of DVT/PE did not differ significantly between the two types of thromboembolic prophylaxis.Conclusion. Pre-operative determination of AT III, whether biologically or immunochemically, did not seem to be successful as screening method of patients to develop DVT/PE.

An Attempt at Predicting Postoperative Deep Vein Thrombosis by Preoperative Coagulation Studies in Patients Undergoing Total Hip Replacement

1980 ◽  
Vol 43 (03) ◽  
pp. 194-197 ◽  
Author(s):  
Dennis W T Nilsen ◽  
Miladin Jeremic ◽  
Odd K Weisert
Keyword(s):  
Deep Vein Thrombosis ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Antithrombin Iii ◽  
Fibrinogen Level ◽  
Additional Parameter ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Uptake Test ◽  
Deep Vein

SummaryPreoperative levels of fibrinogen, factors V, VII, VIII and antithrombin III were measured in 25 consecutive patients undergoing total hip replacement. Deep vein thrombosis (D.V.T.) was detected by fibrinogen-uptake test in 60% of the patients. The preoperative fibrinogen level was significantly higher (p < 0.05), and serum antithrombin III was markedly lower (p ≦ 0.1) in patients with postoperative D.V.T. The quotient of fibrinogen to serum antithrombin III was significantly higher (p < 0.01) in patients with D.V.T. This quotient may serve as an additional parameter to other clinical and laboratory tests in prediction of postoperative D.V.T. following hip surgery.

Hypercoagulability after Total Hip Replacement

1996 ◽  
Vol 6 (1) ◽  
pp. 1-6 ◽  
Author(s):  
M. A. Mcnally ◽  
A. Kyle ◽  
W.R.G. Macdonald ◽  
E. Mayne ◽  
R.A.B. Mollan
Keyword(s):  
Venous Thrombosis ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Antithrombin Iii ◽  
Perioperative Period ◽  
Total Hip ◽  
Transient Nature ◽  
At Iii ◽  
Thrombin Activation ◽  
Clinically Significant

Changes in blood coagulation are believed to be involved in the aetiology of postoperative thromboembolism. Antithrombin III (AT III) is the most important natural inhibitor of thrombin activation and hence thrombogenesis. This study investigated the nature of a hypercoagulable state in total hip replacement by measurement of AT III in the perioperative period, giving a quantitative assessment of coagulation. Antithrombin III levels fell in all patients after surgery. However, the degree of the fall and the timing of the fall were variable. Eight percent of patients had abnormally low AT III prior to operation, indicating that this proportion of our patients are in a procoagulant state even before surgery. One third of patients had a clinically significant reduction (below 70% of normal) in AT III level after surgery. In this group the fall in AT III was maximal at 2 hours after division of the femoral neck. Careful correction for haemodilution provided new evidence for active consumption of antithrombin III in the perioperative period. By 24 hours after surgery the level of AT III was not significantly different from preoperative levels (p>0.7), even in the group with a clinically important reduction. These findings support only a transient period of hypercoagulability after total hip replacement. The “at-risk” period of venous thrombosis has been shown to be at least several weeks after surgery and the transient nature of the fall in AT III suggests that venous thrombosis is unlikely to be due to hypercoagulability alone.

Clinical Utility of Prothrombin Fragment 1+2, Thrombin Antithrombin III Complexes and D-dimer Measurements in the Diagnosis of Deep Vein Thrombosis following Total Hip Replacement

1998 ◽  
Vol 79 (03) ◽  
pp. 509-510 ◽  
Author(s):  
E. Cofrancesco ◽  
A. Corradi ◽  
F. Ravasi ◽  
F. Bertocchi ◽  
M. Cortellaro
Keyword(s):  
Total Hip Replacement ◽  
Hip Replacement ◽  
Antithrombin Iii ◽  
Hip Surgery ◽  
Activation Markers ◽  
Antithrombotic Prophylaxis ◽  
Prothrombin Fragment ◽  
Total Hip ◽  
D Dimer ◽  
Rule Out

SummaryBackground: Measurements of prothrombin fragment 1+2 (F1+2), thrombin antithrombin III complexes (TAT) and D-dimer plasma levels have been proposed as non-invasive screening tests to exclude postoperative deep venous thrombosis (DVT). We investigated the diagnostic efficacy of these coagulation activation markers to rule out postoperative DVT in patients undergoing hip surgery under antithrombotic prophylaxis. Methods: In this substudy of a randomized double-blind thrombosis prophylaxis trial comparing three doses of desirudin (10, 15 or 20 mg b.i.d.) with unfractionated heparin (5000 IU t.i.d.) we used ELISA procedures to measure F1+2, TAT and D-dimer in 159 patients undergoing total hip replacement at baseline (day 0) and on postoperative days 1, 3 and 6. Bilateral venography was performed in all cases 8-11 days after surgery. Results: For the F1+2 assay sensitivity ranged from 73 to 83% in the three postoperative days investigated, and negative predictive value (NPV) from 68 to 74%. For TAT and D-dimer sensitivity ranged from 71 to 73% and from 71 to 83% and NPV from 61 to 65% and from 61 to 74% respectively. Interpretation: In terms of sensitivity and NPV F1+2 and D-dimer are equivalent and are superior to TAT. However, their accuracy is too low to rule out the presence of DVT after hip surgery under antithrombotic prophylaxis.

The Hemodynamic and Fibrinolytic Response to Low Dose Epinephrine and Phenylephrine Infusions During Total Hip Replacement Under Epidural Anesthesia

1992 ◽  
Vol 68 (04) ◽  
pp. 436-441 ◽  
Author(s):  
Nigel E Sharrock ◽  
George Go ◽  
Robert Mineo ◽  
Peter C Harpel
Keyword(s):  
Heart Rate ◽  
Deep Vein Thrombosis ◽  
Cardiac Index ◽  
Total Hip Replacement ◽  
Epidural Anesthesia ◽  
Hip Replacement ◽  
Low Dose ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Deep Vein

SummaryLower rates of deep vein thrombosis have been noted following total hip replacement under epidural anesthesia in patients receiving exogenous epinephrine throughout surgery. To determine whether this is due to enhanced fibrinolysis or to circulatory effects of epinephrine, 30 patients scheduled for primary total hip replacement under epidural anesthesia were randomly assigned to receive intravenous infusions of either low dose epinephrine or phenylephrine intraoperatively. All patients received lumbar epidural anesthesia with induced hypotension and were monitored with radial artery and pulmonary artery catheters.Patients receiving low dose epinephrine infusion had maintenance of heart rate and cardiac index whereas both heart rate and cardiac index declined significantly throughout surgery in patients receiving phenylephrine (p = 0.0001 and p = 0.0001, respectively). Tissue plasminogen activator (t-PA) activity increased significantly during surgery (p <0.0005) and declined below baseline postoperatively (p <0.005) in both groups. Low dose epinephrine was not associated with any additional augmentation of fibrinolytic activity perioperatively. There were no significant differences in changes in D-Dimer, t-PA antigen, α2-plasmin inhibitor-plasmin complexes or thrombin-antithrombin III complexes perioperatively between groups receiving low dose epinephrine or phenylephrine. The reduction in deep vein thrombosis rate with low dose epinephrine is more likely mediated by a circulatory mechanism than by augmentation of fibrinolysis.

Low-Dose Heparin and Deep-Vein Thrombosis after Total Hip Replacement

1976 ◽  
Vol 36 (01) ◽  
pp. 157-164 ◽  
Author(s):  
P. M Mannucci ◽  
Luisa E. Citterio ◽  
N Panajotopoulos
Keyword(s):  
Deep Vein Thrombosis ◽  
Total Hip Replacement ◽  
Hip Replacement ◽  
Low Dose ◽  
Control Group ◽  
Total Hip ◽  
Vein Thrombosis ◽  
Dose Heparin ◽  
Deep Vein ◽  
Low Dose Heparin

SummaryThe effect of subcutaneous low-dose heparin on postoperative deep-vein thrombosis (D. V. T.) (diagnosed by the 125I-labelled fibrinogen test) has been investigated in a trial of 143 patients undergoing the operation of total hip replacement. Two randomized studies were carried out: in one the scanning for D.V.T. was carried out daily for 7 days post operatively and in the other for 15 days. In both, the incidence of D.V.T. was significantly lower in the heparin-treated patients (P<0.005). Bilateral D.V.T. was also prevented (P<0.05), through the extension of D.V.T. to the distal veins of the thigh was not significantly reduced. Heparin treatment was, however, followed by a higher incidence of severe postoperative bleeding (P< 0.02) and wound haematoma formation (P< 0.005), and the postoperative haemoglobin was significantly lower than in the control group (P<0.005). A higher number of transfused blood units was also needed by the heparin treated patients (P<0.001).

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