Hypercoagulability state in hip and knee surgery: influence of ABO antigenic system and allogenic transfusion

It is well know that people with blood group O have a lower risk for venous thromboembolic disease (VTED) than does the general population. Moreover b lood transfusion has been identified as a risk factor for VTED in patients with major trauma. The aim of this work is to investigate the behaviour of several markers of hypercoagulability before and after substitutive surgery of hip and knee in order to evaluate the relationship between the plasmati c levels of these markers, the ABO antigenic system and the allogenic blood transfusion. The plasmatic levels of D dimer (D-D), thrombin - antithrombin complex (TAT ), and fragment 1 + 2 of prothrombin (F1 + 2) have been determined by the E LISA method in 79 patients subject to substitutive surgery of hip or knee o ne day before and one day after surgery. The 41 patients with blood groups different from O had presurgical levels o f Fl + 2 higher than those of group O (p = 0.004), while no differences cou ld be found for D-D and TAT. The 28 patients who received allogenic blood p resented higher levels of D-D one day after surgery than non-transfused pat ients (p = 0.043); the practice of transfusion did not modify significantly the levels of TAT and Fl + 2 after surgery. In accordance with these results we suggest that blood group and transfusio n are risk factors for hypercoagulability, and therefore we advise for a re strictive policy of transfusion practice. New therapies such as aprotinin s hould be assayed in order to minimize blood loss. (C) 1999 Published by Els evier Science Ltd. All rights reserved.