[Evaluation of selected parameters of blood coagulation and the fibrinolysis system in patients undergoing total hip replacement].

Patients undergoing orthopedic surgery, particularly total hip replacement procedure belong to a group of patients with a high risk of thromboembolic complications. Postoperative deep vein thrombosis may occur in 40-80% of these patients. 4-19% of patients develop clinically evident pulmonary embolism and approximately 7% of cases in this group result in death. A thorough evaluation of coagulation disorders in the perioperative period could lead to detecting risk factors of thromboembolic complications development and could facilitate more effective prophylaxis management. The aim of the study was to evaluate the dynamics of selected blood coagulation and fibrinolysis parameters in patients undergoing total hip replacement surgery. The study included 66 patients undergoing total hip replacement surgery. The group consisted of 51 women and 15 men, within the age range of 47-78, the mean age was 64. In 32 (group A) patients surgery was performed with the use of normovolemic hemodilution, in 34 (group B) the hemodilution procedure was not applied. The patients received low molecular heparin as prophylaxis started 12 hours prior surgery and continued for 5 weeks after. The examination of the coagulation system was performed: in the morning on the day of the operation--examination 1, on the day of the operation in the evening--examination 2, and on the first day after operation--examination 3. We determined the concentrations of thrombin-antithrombin complexes (TAT), prothrombin fragments 1 + 2 (F1 + 2), D-dimers (DD) and plasminantiplasmin complexes (PAP). In all the patients an ultrasound examination of the lower limbs by Doppler method was performed before the surgery and 10-12 days after the procedure. Significant activation of coagulation and fibrinolysis was found in all patients before surgery. 12 hour after the procedure a progressive increase of coagulation disorders was observed. After 24 hours marked decrease of coagulation parameters was noted. In group A significantly less thromboembolic complications was observed. On the basis of the performed examinations the following conclusions were drawn. (1) during total hip replacement surgery and particularly during the period of the first 12 hours after procedure, marked activation of coagulation and fibrinolysis occurred. (2) the application of the hemodilution procedure does not influence significantly the degree of coagulation and fibrinolysis disorders in the perioperative period.