CHANGES IN COAGULATORY PROFILE AFTER ORTHOPEDIC-SURGERY

Platelet count, prothrombin time (PT), partial thromboplastin time (PT T) and fibrinogen concentrations were prospectively evaluated in 65 pa tients undergoing orthopedic surgery at the National Cheng-Kung Univer sity Hospital between June 1990 and February 1991. All patients were h ospitalized for at least 7 days after surgery. Coagulation data were c ollected preoperatively and on the first, third and seventh postoperat ive days (POD 1, 3, 7). The average estimated blood loss was 374 mt (r ange, 25-2,350 mL). Stored whole blood transfusion of 2 to 5 units (1 unit = 250 mL) was required by 12 patients. A further 12 patients rece ived a transfusion of two to six units of packed red cells. Platelet c ount decreased to the lowest level on POD 1, recovered to normal on PO D 3 and was even greater by POD 7. PT was prolonged on POD 1, recovere d by POD 3 and remained stable on POD 7, PTT was prolonged on POD 1, b ecame more prolonged on POD 3 and returned to normal by POD 7. Fibrino gen concentrations were not significantly altered on POD 1, but increa sed above the preoperative level on POD 3 and returned gradually to no rmal by POD 7. Variables such as age, sex, type of operation and durat ion of tourniquet did not affect these patterns. There was a positive correlation between duration of surgery, net blood loss and decrease i n platelet count. This study examined some of the physiologic coagulat ory variations after orthopedic surgery. Recognition of these patterns might lead to better clinical judgment when perioperative coagulatory disorders are suspected.