Factors predisposing to thrombosis after major joint arthroplasty

• 作者: Apostolos Dimitroulias Despoina Kyriakou Konstantinos N Malizos Nikolaos Rigopoulos Nikolaos Stefanou Panagoula Kollia Sokratis Varitimids TheofilosKarachalios Zoe H Dailiana
• 来源期刊: 世界骨科杂志:英文版
• 学科: 医学
• 关键词: ARTHROPLASTY THROMBOSIS Heparin-induced thrombocytopenia Coagulation factors Low-molecular-weight heparin FONDAPARINUX
• 年，卷（期）: 2020,（9）
• 页码范围: 400-410
• 页数: 11页
• 分类号: R68

摘要

BACKGROUND Total joint arthroplasty is one of the most common options for end stage osteoarthritis of major joints.However,we must take into account that thrombosis after hip/knee arthroplasty may be related to mutations in genes encoding for blood coagulation factors and immune reactions to anticoagulants[heparininduced thrombocytopenia(HIT)/thrombosis].Identifying and characterizing genetic risk should help to develop diagnostic strategies or modify anticoagulant options in the search for etiological mechanisms that cause thrombophilia following major orthopedic surgery.AIM To evaluate the impact of patients’coagulation profiles and to study specific pharmacologic factors in the development of post-arthroplasty thrombosis.METHODS In 212(51 male and 161 female)patients that underwent primary total hip arthroplasty(100)or total knee arthroplasty(112)due to osteoarthritis during a period of 1 year,platelet counts and anti-platelet factor 4(PF4)/heparin antibodies were evaluated pre/postoperatively,and antithrombin III,methylenetetrahydrofolate reductase,factor V and prothrombin gene mutations were evaluated preoperatively.In a minimum follow-up of 3 years,196 patients receiving either low-molecular-weight heparins(173)or fondaparinux(23)were monitored for the development of thrombocytopenia,anti-PF4/heparin antibodies,HIT,and thrombosis.RESULTS Of 196 patients,32 developed thrombocytopenia(nonsignificant correlation between anticoagulant type and thrombocytopenia,P=0134.)and 18 developed anti-PF4/heparin antibodies(12/173 for low-molecular-weight heparins and 6/23 for fondaparinux;significant correlation between anticoagulant type and appearance of antibodies,P=0.005).Odds of antibody emergence:8.2%greater in patients receiving fondaparinux than low-molecular-weight heparins.Gene mutations in factor II or V(two heterozygotes for both factor V and II)were identified in 15 of 196 patients.Abnormal low protein C and/or S levels were found in 3 of 196(1.5%)patients,while all patients had normal levels of von Willebr