COAGULATION ACTIVATION MARKERS IN THE PREDICTION OF VENOUS THROMBOSISAFTER ELECTIVE HIP-SURGERY

Background. Despite prophylaxis, deep vein thrombosis (DVT) after hip surgery continues to occur frequently. Thus it would be helpful if bef ore surgery patients at higher risk of DVT could be identified and mor e adequate prophylaxis given. As part of an international study on the prevention of DVT after total hip replacement, we investigated whethe r preoperative levels of three coagulation activation markers, prothro mbin fragment F1+2 (F1+2), thrombin-antithrom bin III complexes (TAT) and D-dimer, correlate with results of post-operative venography. Meth ods. 159 patients undergoing total hip replacement were randomized to receive 10, 15 or 20 mg desirudin bid or 5000 IU unfractionated hepari n tid immediately before surgery and then for 11 days, until bilateral venography was performed. Preoperative F1+2, TAT and D-dimer plasma l evels were measured using ELISA procedures. As no difference among ant icoagulant treatments or in the interaction between treatments and DVT was detected for any of the three variables, results are reported as pooled data. Findings. The frequency of DVT was 18.8% in the low (0.75 -1.33 nM) vs 65.7% in the high third of distribution (1.77-3.47 nM) of F1+2 (p < .001), 27.3% in the low (2.00-2.50 mu g/l) vs 57% ir;the hi gh third (5.10-61.00 mu g/l) of TAT (p = .042), and 29.4% in the low ( 39-59 mu g/l) vs 57.1% in the high third (129-651 mu g/l) of D-dimer ( p = .051). Interpretation, Preoperative F1+2, TAT and D-dimer levels a re associated with the risk of development of DVT after total hip repl acement.