个性化延迟抗凝疗法可减轻全膝关节置换术（TKA）患者的术后出血。

IF 2 Q2 ORTHOPEDICS Journal of Experimental Orthopaedics Pub Date : 2024-10-30 DOI:10.1002/jeo2.70074

Xuefeng Luo, Dehua Wang, Wei Xu, Jing Zou, Runxing Kang, Tao Zhang, Xi Liang, Junyi Liao, Wei Huang

{"title":"个性化延迟抗凝疗法可减轻全膝关节置换术（TKA）患者的术后出血。","authors":"Xuefeng Luo, Dehua Wang, Wei Xu, Jing Zou, Runxing Kang, Tao Zhang, Xi Liang, Junyi Liao, Wei Huang","doi":"10.1002/jeo2.70074","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>Ecchymosis is one of the most common complications following total knee arthroplasty (TKA), which is closely related to postoperative bleeding. However, it is still controversial whether anticoagulation treatment should be continued for postoperative ecchymosis patients. We suppose that personalized delayed anticoagulation therapy could be beneficial for decreasing postoperative bleeding.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>A total of 201 TKA patients were retrospectively included in this study, among whom ecchymosis patients received drug anticoagulation treatment 1–2 days later than usual, while nonecchymosis patients received regular drug anticoagulation treatment. The perioperative blood loss, coagulation state, fibrinolytic state and complications were collected and analyzed.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Eighty-nine patients (44.3%) developed ecchymosis within 3 days after TKA. There were no differences in baseline characteristics between the two groups. In the ecchymosis group, higher K values and lower calculated coagulation index values were observed in thromboelastography, along with greater total blood loss and a more significant decrease in haemoglobin levels on postoperative Day 1 (POD1) compared to the nonecchymosis group. Additionally, the ecchymosis patients exhibited higher levels of fibrinogen degradation products and D-dimer (D-D) on POD1, with no differences noted on POD3, indicating that patients with ecchymosis are in a relatively hypocoagulable and hyperfibrinolytic state compared to those without ecchymosis. Therefore, the delayed anticoagulation treatment proved beneficial for correcting these postoperative conditions. No statistically significant differences were found between the two groups in postoperative complications, demonstrating that delayed anticoagulation treatment is safe.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>Patients with ecchymosis exhibited a relatively hypocoagulable and hyperfibrinolytic state with a stronger tendency for postoperative bleeding. Delayed anticoagulation in ecchymosis patients could effectively prevent further exacerbation of postoperative bleeding by avoiding sustained hypocoagulable and hyperfibrinolysis states. Personalized delayed anticoagulation therapy could be beneficial for managing postoperative ecchymosis for TKA patients.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level IV.</p>\n </section>\n </div>","PeriodicalId":36909,"journal":{"name":"Journal of Experimental Orthopaedics","volume":"11 4","pages":""},"PeriodicalIF":2.0000,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522910/pdf/","citationCount":"0","resultStr":"{\"title\":\"Personalized delayed anticoagulation therapy alleviates postoperative bleeding in total knee arthroplasty (TKA) patients\",\"authors\":\"Xuefeng Luo, Dehua Wang, Wei Xu, Jing Zou, Runxing Kang, Tao Zhang, Xi Liang, Junyi Liao, Wei Huang\",\"doi\":\"10.1002/jeo2.70074\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>Ecchymosis is one of the most common complications following total knee arthroplasty (TKA), which is closely related to postoperative bleeding. However, it is still controversial whether anticoagulation treatment should be continued for postoperative ecchymosis patients. We suppose that personalized delayed anticoagulation therapy could be beneficial for decreasing postoperative bleeding.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>A total of 201 TKA patients were retrospectively included in this study, among whom ecchymosis patients received drug anticoagulation treatment 1–2 days later than usual, while nonecchymosis patients received regular drug anticoagulation treatment. The perioperative blood loss, coagulation state, fibrinolytic state and complications were collected and analyzed.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Eighty-nine patients (44.3%) developed ecchymosis within 3 days after TKA. There were no differences in baseline characteristics between the two groups. In the ecchymosis group, higher K values and lower calculated coagulation index values were observed in thromboelastography, along with greater total blood loss and a more significant decrease in haemoglobin levels on postoperative Day 1 (POD1) compared to the nonecchymosis group. Additionally, the ecchymosis patients exhibited higher levels of fibrinogen degradation products and D-dimer (D-D) on POD1, with no differences noted on POD3, indicating that patients with ecchymosis are in a relatively hypocoagulable and hyperfibrinolytic state compared to those without ecchymosis. Therefore, the delayed anticoagulation treatment proved beneficial for correcting these postoperative conditions. No statistically significant differences were found between the two groups in postoperative complications, demonstrating that delayed anticoagulation treatment is safe.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>Patients with ecchymosis exhibited a relatively hypocoagulable and hyperfibrinolytic state with a stronger tendency for postoperative bleeding. Delayed anticoagulation in ecchymosis patients could effectively prevent further exacerbation of postoperative bleeding by avoiding sustained hypocoagulable and hyperfibrinolysis states. Personalized delayed anticoagulation therapy could be beneficial for managing postoperative ecchymosis for TKA patients.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Level of Evidence</h3>\\n \\n <p>Level IV.</p>\\n </section>\\n </div>\",\"PeriodicalId\":36909,\"journal\":{\"name\":\"Journal of Experimental Orthopaedics\",\"volume\":\"11 4\",\"pages\":\"\"},\"PeriodicalIF\":2.0000,\"publicationDate\":\"2024-10-30\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11522910/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Experimental Orthopaedics\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://onlinelibrary.wiley.com/doi/10.1002/jeo2.70074\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"ORTHOPEDICS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Experimental Orthopaedics","FirstCategoryId":"1085","ListUrlMain":"https://onlinelibrary.wiley.com/doi/10.1002/jeo2.70074","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ORTHOPEDICS","Score":null,"Total":0}

引用次数: 0

摘要

目的：瘀斑是全膝关节置换术（TKA）后最常见的并发症之一，与术后出血密切相关。然而，术后瘀斑患者是否应继续接受抗凝治疗仍存在争议。我们认为，个性化的延迟抗凝治疗可能有利于减少术后出血：方法：本研究回顾性纳入了 201 例 TKA 患者，其中瘀斑患者接受药物抗凝治疗的时间比平常晚 1-2 天，而非瘀斑患者接受常规药物抗凝治疗。收集并分析了围手术期的失血量、凝血状态、纤溶状态和并发症：结果：89 名患者（44.3%）在 TKA 术后 3 天内出现瘀斑。两组患者的基线特征无差异。与无瘀斑组相比，瘀斑组在血栓弹力图中观察到更高的 K 值和更低的凝血指数计算值，同时总失血量更大，术后第 1 天（POD1）血红蛋白水平下降更明显。此外，瘀斑患者在术后第 1 天的纤维蛋白原降解产物和 D-二聚体（D-D）水平较高，而在术后第 3 天则无差异，这表明与无瘀斑患者相比，瘀斑患者处于相对低凝和高纤维蛋白溶解状态。因此，延迟抗凝治疗有利于纠正这些术后状况。两组患者在术后并发症方面没有统计学差异，这表明延迟抗凝治疗是安全的：结论：瘀斑患者的凝血功能和纤维蛋白溶解功能相对较低，术后出血倾向较强。对瘀斑患者进行延迟抗凝治疗可避免持续的低凝状态和高纤维蛋白溶解状态，从而有效防止术后出血进一步加重。个性化的延迟抗凝疗法有利于治疗 TKA 患者术后瘀斑：证据等级：IV 级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

摘要图片

查看原文

微信好友朋友圈 QQ好友复制链接

本刊更多论文

Personalized delayed anticoagulation therapy alleviates postoperative bleeding in total knee arthroplasty (TKA) patients

Purpose

Ecchymosis is one of the most common complications following total knee arthroplasty (TKA), which is closely related to postoperative bleeding. However, it is still controversial whether anticoagulation treatment should be continued for postoperative ecchymosis patients. We suppose that personalized delayed anticoagulation therapy could be beneficial for decreasing postoperative bleeding.

Methods

A total of 201 TKA patients were retrospectively included in this study, among whom ecchymosis patients received drug anticoagulation treatment 1–2 days later than usual, while nonecchymosis patients received regular drug anticoagulation treatment. The perioperative blood loss, coagulation state, fibrinolytic state and complications were collected and analyzed.

Results

Eighty-nine patients (44.3%) developed ecchymosis within 3 days after TKA. There were no differences in baseline characteristics between the two groups. In the ecchymosis group, higher K values and lower calculated coagulation index values were observed in thromboelastography, along with greater total blood loss and a more significant decrease in haemoglobin levels on postoperative Day 1 (POD1) compared to the nonecchymosis group. Additionally, the ecchymosis patients exhibited higher levels of fibrinogen degradation products and D-dimer (D-D) on POD1, with no differences noted on POD3, indicating that patients with ecchymosis are in a relatively hypocoagulable and hyperfibrinolytic state compared to those without ecchymosis. Therefore, the delayed anticoagulation treatment proved beneficial for correcting these postoperative conditions. No statistically significant differences were found between the two groups in postoperative complications, demonstrating that delayed anticoagulation treatment is safe.

Conclusion

Patients with ecchymosis exhibited a relatively hypocoagulable and hyperfibrinolytic state with a stronger tendency for postoperative bleeding. Delayed anticoagulation in ecchymosis patients could effectively prevent further exacerbation of postoperative bleeding by avoiding sustained hypocoagulable and hyperfibrinolysis states. Personalized delayed anticoagulation therapy could be beneficial for managing postoperative ecchymosis for TKA patients.