Malin S Carling1, Josef Zarhoud2, Anders Jeppsson3, Bengt I Eriksson4, Helena Brisby5. 1. Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden. Electronic address: malin.carling@gmail.com. 2. Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden. Electronic address: josef.zarhoud@vgregion.se. 3. Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: anders.jeppsson@vgregion.se. 4. Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden. Electronic address: b.eriksson@orthop.gu.se. 5. Department of Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Orthopaedics, Institute of Clinical Science, Sahlgrenska Academy University of Gothenburg, Gothenburg, Sweden. Electronic address: helena.brisby@vgregion.se.
Abstract
BACKGROUND: Major orthopaedic surgery involves a calculated risk of bleeding. In other groups of surgical patients, low preoperative plasma fibrinogen concentration and factor XIII (FXIII) activity have been associated with an elevated risk of bleeding. In the present study we investigated the association between preoperative fibrinogen plasma concentration and FXIII activity on bleeding and transfusion requirements in patients undergoing a spinal fusion procedure or hip or knee arthroplasty. METHODS: Two hundred and forty-five adult patients undergoing spine fusion surgery (n=52), total unilateral primary hip arthroplasty (n=114), or total knee arthroplasty (n=79) were included in a prospective observational study. Blood samples were collected <24h before surgery and analysed for fibrinogen concentration and FXIII activity. Intraoperative and postoperative bleeding volume and transfusion requirements were recorded. RESULTS: Spinal fusion surgery patients with a low preoperative fibrinogen concentration (≤2.5g/L) had a greater total perioperative median bleeding volume than patients with fibrinogen>2.5g/L (2430 (400-6560) mL vs. 1390 (400-7420) mL, p=0.029). No significant association between low fibrinogen levels and perioperative bleeding volume was observed for arthroplasty patients. There was no association between low fibrinogen levels and transfusion requirements in any of the groups. Low FXIII activity was not significantly associated with bleeding volume and transfusion requirements in any group. CONCLUSION: Measurement of preoperative fibrinogen plasma concentration can identify spinal fusion patients with an increased risk of excessive perioperative bleeding. Measurement of FXIII activity cannot identify orthopaedic patients with elevated risk of bleeding.
BACKGROUND: Major orthopaedic surgery involves a calculated risk of bleeding. In other groups of surgical patients, low preoperative plasma fibrinogen concentration and factor XIII (FXIII) activity have been associated with an elevated risk of bleeding. In the present study we investigated the association between preoperative fibrinogen plasma concentration and FXIII activity on bleeding and transfusion requirements in patients undergoing a spinal fusion procedure or hip or knee arthroplasty. METHODS: Two hundred and forty-five adult patients undergoing spine fusion surgery (n=52), total unilateral primary hip arthroplasty (n=114), or total knee arthroplasty (n=79) were included in a prospective observational study. Blood samples were collected <24h before surgery and analysed for fibrinogen concentration and FXIII activity. Intraoperative and postoperative bleeding volume and transfusion requirements were recorded. RESULTS: Spinal fusion surgery patients with a low preoperative fibrinogen concentration (≤2.5g/L) had a greater total perioperative median bleeding volume than patients with fibrinogen>2.5g/L (2430 (400-6560) mL vs. 1390 (400-7420) mL, p=0.029). No significant association between low fibrinogen levels and perioperative bleeding volume was observed for arthroplasty patients. There was no association between low fibrinogen levels and transfusion requirements in any of the groups. Low FXIII activity was not significantly associated with bleeding volume and transfusion requirements in any group. CONCLUSION: Measurement of preoperative fibrinogen plasma concentration can identify spinal fusion patients with an increased risk of excessive perioperative bleeding. Measurement of FXIII activity cannot identify orthopaedic patients with elevated risk of bleeding.
Authors: Chen Changjun; Zhao Xin; Luo Yue; Zhao Chengcheng; Wang Qiuru; Li Qianhao; Kang Pengde Journal: Int Orthop Date: 2021-08-18 Impact factor: 3.075
Authors: Giuseppe Ristagno; Simonetta Beluffi; Dario Tanzi; Federica Belloli; Paola Carmagnini; Massimo Croci; Giuseppe D'Aviri; Guido Menasce; Juan C Pastore; Armando Pellanda; Alberto Pollini; Giorgio Savoia Journal: J Clin Med Date: 2018-01-30 Impact factor: 4.241