scholarly journals Impact of the Initial Coagulation Parameters and the Time Interval between Hemostatics and Anti coagulants on the Risk of Thrombohemorrhagic Complications After Endoprosthetics of Large Joints

Biomeditsina ◽  
2021 ◽  
Vol 17 (3) ◽  
pp. 34-38
Author(s):  
L. S. Golovko ◽  
A. V. Safronenko ◽  
Yu. S. Maklyakov ◽  
E. V. Gantsgorn ◽  
N. V. Sukhorukova ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Anticoagulant Therapy ◽  
Postoperative Period ◽  
Joint Replacement ◽  
Lower Extremities ◽  
Early Postoperative Period ◽  
Time Interval ◽  
Male And Female ◽  
Coagulation Parameters ◽  
Female Patients

The article confirms the significance of the time interval of at least 18 hours between the hemostatic and anticoagulant therapy, which is of particular importance when tranexamic acid is used. An analysis of the thrombohemorrhagic complications developed in the early postoperative period after arthroplasty of large joints of the lower extremities was carried out. In addition, the most significant coagulation parameters were determined, whose deviation from the norm before surgery increased the risk of thrombosis and bleeding after joint replacement among male and female patients.

scholarly journals Combined Prevention of Thrombosis and Hemorrhagic Complications in Patients after Replacement of the Knee or Hip Joint

Biomeditsina ◽  
2020 ◽  
Vol 16 (3) ◽  
pp. 81-85
Author(s):  
L. S. Golovko ◽  
A. V. Safronenko ◽  
E. V. Gantsgorn ◽  
N. V. Sukhorukova ◽  
E. S. Postnikova ◽  
...  
Keyword(s):  
Tranexamic Acid ◽  
Anticoagulant Therapy ◽  
Hip Joint ◽  
Hip Arthroplasty ◽  
Postoperative Period ◽  
Early Postoperative Period ◽  
Time Interval ◽  
Prevention Of Thrombosis ◽  
Hemorrhagic Complications ◽  
Knee And Hip Arthroplasty

The article demonstrates the importance of observing the time interval between hemostatic and anticoagulant therapy for at least 18 hours, particularly when using tranexamic acid as a hemostatic drug. The developed complications of a thrombotic and hemorrhagic nature in the early postoperative period after knee and hip arthroplasty were analyzed. Schemes of hemostatic and anticoagulant agents, which developed thrombosis and hemorrhagic complications, were also determined.

scholarly journals Thrombosis and bleeding after endoprosthetics of large joints of the lower extremities: what can increase the risk of thrombohemorrhagic complications?

2020 ◽  
Vol 1 (3) ◽  
pp. 75-83
Author(s):  
L. S. Golovko ◽  
A. V. Safronenko ◽  
E. V. Gantsgorn
Keyword(s):  
Tranexamic Acid ◽  
Postoperative Period ◽  
Lower Extremities ◽  
International Normalized Ratio ◽  
Early Postoperative Period ◽  
Time Interval ◽  
Hip Joints ◽  
Risk Of Bleeding ◽  
Anticoagulant Drugs

Objective: to assess the effect of the baseline hemostasiogram and comorbid background on the development of thrombosis and bleeding in the early postoperative period in patients receiving combined hemostatic and anticoagulant pharmacoprophylaxis after arthroplasty of the knee and hip joints.Materials and Methods: A retrospective analysis of 253 case histories of patients with hip or knee arthroplasty performed. The patients received combined pharmacoprophylaxis with hemostatics and anticoagulants. Two groups were identified according to the time interval (TI) between the appointment of hemostatic and anticoagulant drugs. The first group (57,31%) - n=145 (112 women and 33 men), TI≤17 h, the second group (42,68%) — n=108 (78 women and 30 men), TI 18-24 h. In patients, we analyzed the effect of comorbidity and baseline values of the coagulogram on the risk of thrombosis or bleeding in the early postoperative period.Results: Thrombohemorrhagic complications were registered in 27 (10,67%) patients, of which 22 (81,48%) were in the first group. Thrombosis in the first group developed in the regimens with tranexamic acid (p=0,038), and their frequency was 2,2 times higher than in the second group (p=0,023). In the first group, the risk of thrombosis in women was increased by the initially low level of international normalized ratio (INR) (relative risk (RR)=13,333, p=0,00032) and activated partial thromboplastin time (APTT) (RR=5,8, p=0,037). The risk of bleeding in the first group among men and women increased with an increased preoperative APTT level (RR=18, p=0,0012 and RR=28, p=0,00022, respectively), and separately for women - with a reduced content of fibrinogen (RR=23,25, p=0,00065) and platelets (RR=10,2, p=0,038). The development of thrombosis as influenced by: degree 2 obesity (RR=8,75, p=0,037), type 2 diabetes mellitus (RR=21, p=0,00001), myocardial infarction (RR=16,875, p=0,00002), venous pathology (RR=8,1, p=0,045), moderate decline in renal function (RR=6,231, p=0,0465) and age over 75 years (RR=6,8, p=0,029). Age over 75 years increased the risk of bleeding 12-fold (RR=12, p=0,015).Conclusions: to minimize the risk of thrombosis and bleeding after endoprosthetics of large joints of the lower extremities, especially in patients with the above risk factors, in particular, when using tranexamic acid as a hemostatic, it is recommended to observe the TI between hemostatic and anticoagulant pharmacoprophylaxis of at least 18 hours.

Postoperative Anesthesia Of Elderly And Senile Patients With Total Joint Replacement Of The Lower Extremities

2020 ◽  
Vol 2 (09) ◽  
pp. 75-81
Author(s):  
Gaziev Z.T. ◽  
Avakov V.E. ◽  
Shorustamov M.T. ◽  
Bektemirova N.T.
Keyword(s):  
Epidural Analgesia ◽  
Postoperative Period ◽  
Joint Replacement ◽  
Total Joint Replacement ◽  
Lower Extremities ◽  
Multimodal Analgesia ◽  
Control Group ◽  
Patient Controlled Analgesia ◽  
Physical Status ◽  
Traumatic Injuries

Objective: To evaluate the efficacy and safety of patient-controlled analgesia through prolonged epidural analgesia after joint replacement of the lower extremities. Material and methods. We analyzed the postoperative period of 213 elderly and senile patients who were operated on for degenerative-dystrophic and traumatic injuries of the joints of the lower extremities. All patients underwent total joint replacement (164 - THA and 49 - TKA). The age of patients is from 65 to 90 years (average age was 78 ± 8 years) with a physical status of ASA 3 and above. All examined patients were divided into 2 groups. 63 patients comprised the main group, which in the postoperative period underwent patient-controlled analgesia (PCA) through prolonged epidural analgesia. The control group consisted of 150 patients, for the anesthesia of which in the postoperative period only standard systemic multimodal analgesia was used Conclusion. Patient-controlled analgesia is an alternative to traditional analgesic regimens. This method should be one of the main methods after surgical anesthesia for joint replacement of the lower limb in elderly and senile patients.

scholarly journals FORMATION OF OUTFLOW PATHWAYS IN PATIENTS WITH COMBINED STENOTIC-OCCLUSIVE LESIONS OF THE FEMORAL AND TIBIAL ARTERIAL SEGMENTS

2021 ◽  
Vol 4 (18) ◽  
pp. 38-44
Author(s):  
S.Y. Kostiv ◽  
I.K. Venger ◽  
B.Y. Maslii ◽  
B.P. Selskyi ◽  
N.I. Tsiupryk ◽  
...  
Keyword(s):  
Postoperative Period ◽  
Lower Extremities ◽  
Early Postoperative Period ◽  
Arterial Blood Flow ◽  
Arterial Segment ◽  
Arterial Blood ◽  
Tibial Arteries ◽  
Group I ◽  
Hybrid Revascularization ◽  
Stenotic Lesions

                The aim of the study. To prevent the development of postoperative thrombosis of the reconstruction segment after endovascular and hybrid revascularization of the femoral-distal arterial portion in the conditions of stenotic-occlusive process of the tibial arteries by forming functionally capable pathways in the tibial segment.                 Materials and methods. The results of treatment 135 patients with atherosclerotic occlusive-stenotic lesions of the infrainguinal arterial segment of the lower extremities were analyzed. According to the severity violation of chronic arterial insufficiency of the lower extremities, grade IIB was detected in 50 (37.04%) patients, grade III - in 63 (46.66%) examinee, grade IV- in 22 (16.30%) examinee. Patients were divided into 2 groups. Group I included 61 (45.19%) patients with occlusal-stenotic lesions at the level of the infrainguinal segment, who underwent only endovascular correction of the peripheral arterial portion, the second group consisted of 74 (54.81%) patients with multilevel occlusive-stenotic lesions of the infrainguinal arterial segment which was performed hybrid arterial reconstruction.                 Results and discussion. The proposed tactic involves endovascular angioplasty of at least two tibial arteries. During revascularization of 135 patients by endovascular (61 supervision) and hybrid (74 supervision) methods of a femoral-distal arterial blood flow under conditions of arterial sclerotic disease of tibial arteries carried out in 115 (85,18%) patients endovascular dilatation of two arteries. Thrombosis of the reconstruction segment in the postoperative period was finding in 9 (6.67%) cases: when using endovascular and hybrid revascularization methods, respectively - in 4 (6.56%) and 5 (6.76%) cases. Thrombosis of the reconstruction segment in the early postoperative period in 8 cases developed after endovascular angioplasty of one of the tibial arteries and only in 1 observation after endovascular angioplasty of 2 tibial arteries.                 Conclusion. Reconstruction of outflow pathways at the tibial arterial segment with occlusive-stenotic lesions of the infranguinal arterial portion during endovascular and hybrid techniques of revascularization by performing angioplasty of the two tibial arteries of the tibia can provide a positive result of revascularization in the early postoperative period, respectively in 95.08% and 95.95% of cases.

New Measures for Prevention of Intra- and Postoperative Complications at Total Hip Replacement

2010 ◽  
Vol 17 (1) ◽  
pp. 25-28
Author(s):  
I F Akhtyamov ◽  
G G Garifullov ◽  
A N Kovalenko ◽  
I I Kuz'min ◽  
A G Rykov
Keyword(s):  
Postoperative Complications ◽  
Postoperative Period ◽  
Joint Replacement ◽  
Hip Replacement ◽  
Early Postoperative Period ◽  
Periprosthetic Fractures ◽  
Early Postoperative Complications ◽  
Motion Activity ◽  
Implant Dislocation ◽  
Surgical Prevention

The reasons of intraoperative and early postoperative complications i.e. implant dislocation and periprosthetic fractures, after hip replacement were analyzed and ways of their surgical prevention were elaborated. After 497 operations dislocation of the femoral component was detected in 24 (4,8%) cases including 15 - in the early postoperative period. The main reason of complication was inobservance of the prescribed motion activity regimen in the first postoperative days. In primary joint replacement periprosthetic fractures occurred in19 (3,8%) cases: in 15 (3%) cases the fracture developed intraoperatively and in 4 (0,8%) cases - after patients' discharge from the hospital. Application of the elaborated techniques of surgical prevention enabled to minimize the risk of such complications.

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