SEQUENTIAL INTRAPULMONARY AND SYSTEMIC ACTIVATION OF COAGULATION AND FIBRINOLYSIS DURING AND AFTER TOTAL HIP-REPLACEMENT SURGERY

Hip joint replacement surgery, using acrylic cement for prosthesis fix ation, is associated with intraoperative cardiorespiratory dysfunction , and a high frequency of postoperative proximal deep vein thrombosis (DVT). Levels of prothrombin fragments 1+2 (F1+2), tissue plasminogen activator antigen (t-PA), plasminogen activator inhibitor 1 activity ( PAI-1), D-dimer and interleukin 6 (IL-6) were measured in arterial (AB ) and mixed venous blood (MVB) in five patients during and after total hip replacement operation with acrylic cement prosthesis fixation. Se quential peaks of F1+2, t-PA, PAI-1 and IL-6 appeared, starting with a ctivation of coagulation during preparation of bone, closely followed by activation of fibrinolysis. Later, this was counteracted by an anti fibrinolytic response and increase of IL-6. After a fibrinolytic shutd own on the third postoperative day as evidenced by a drop in t-PA and D-dimer concentrations, a second wave of coagulation was seen at the e nd of the first week. The present model, with frequent sampling of blo od entering and leaving the lungs, confirms our earlier findings of th e lung as a key organ in promoting coagulation following traumatic act ivation.