POSTOPERATIVE ACTIVATION OF THE HEMOSTATIC SYSTEM - INFLUENCE OF PROLONGED THROMBOPROPHYLAXIS IN PATIENTS UNDERGOING TOTAL HIP-ARTHROPLASTY

Tissue injury during hip surgery results in the activation of the haem ostatic system. The aim of this study was to detect markers of haemost atic activity, i.e. prothrombin fragment 1 and 2 (F1+2), thrombin-anti thrombin (TAT) complexes, fibrin degradation products (FbDP), and solu ble fibrin monomers (SF), preoperatively, and on days i, 7 and 35 in p lasma of patients undergoing total hip arthroplasty. The study was par t of a multicentre study in which the patients were randomized to rece ive a subcutanous injection of low molecular weight heparin (LMWH, dal teparin, Fragmin(R)) once daily for 5 weeks or placebo following a 1-w eek LMWH treatment (once daily). Bilateral phlebography was performed between days 33 and 35 or before if patients had clinical symptoms of deep vein thrombosis. A lung scan was performed in patients with clini cal symptoms of pulmonary embolism. Levels of the markers were signifi cantly increased on day 35 in the patients receiving LMWH for 7 days c ompared to patients receiving LMWH for 35 days. In patients receiving LMWH for 5 weeks, levels of FbDP and SF were significantly higher duri ng the entire study period, but TAT and F1+2 were normalized on day 35 . The markers were increased two to five times on the ist postoperativ e day in patients with diagnosed venous thromboembolism.