Preoperative thrombinogenesis state in patients with uncomplicated perioperative period after knee and hip joint replacement

Abstract

Summary. Introduction. Endoprosthetics of large joints of the lower extremities is associated with an increased risk of thrombotic complica- tions, despite the use of modern anticoagulant and antifibrinolytic agents. Aim: to determine the nature of the thrombinogenesis during the preoperative period in patients with deforming osteoarthritis of the hip and knee joints, in whom joint replacement was accompanied by an uncomplicated immediate postoperative period. Materials and Methods. We conducted a retrospective randomized parallel-group cohort study that included a total of 57 examined patients with stage I–II hip and knee osteoarthritis (n = 15, control group) and stage III–IV (n = 42, main group) according to the Kellgren–Lawrence classification. The patients of the main group are divided into two subgroups according to the site of the pathological process. The coagulation plasma properties were studied using a screening coagulation profile, which included the determination of activated partial thromboplastin time, prothrombin time, thrombin time, and fibrinogen level. In addition, the para- meters of thrombin generation assay (TGA) with RB (2 pmol/ml tissue factor) and RC-low (5 pmol/ml tissue factor) activators were recorded.

The state of the lower extremity veins was examined before surgery, on the first day and 5–7 days after joint replacement using duplex scan- ning. Results. Screening tests values in patients with stage III–IV osteoarthritis did not differ from those in the control group. TGA revealed increased thrombin activity in patients with stage III–IV osteoarthrosis of large joints of the lower extremities compared to that in the compa- rison group; at the same time, an adequate response to the RC-low activator was maintained (thrombinogenesis was more pronounced in response to the strong RC-low activator compared to the weak RB activator). Conclusion. For patients with an uncomplicated immediate postoperative period, a normoreactive thrombinogenesis is typical with initial thrombinemia. With this type of thrombinogenesis, the risk of thrombotic complications associated with the functional state of the hemocoagulation system is minimized.

For citation: Puchinyan D.M., Sadchikov D.D., Shakhmartova S.G., Norkin I.A. Preoperative thrombinogenesis state in patients with uncomplicated perioperative period after knee and hip joint replacement. Tromboz, gemostaz i reologiya. 2025;(4):39–48. (In Russ.).

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