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Platelet aggregation and coagulation factors in orthopedic surgery

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Abstract

Hemostasis is a major concern during the perioperative period. Changes in platelet aggregation and coagulation factors may contribute to the delicate balance between thrombosis and bleeding. We sought to better understand perioperative hemostasis by investigating the changes in platelet aggregation and coagulation factors during the perioperative period. We performed a prospective cohort analysis of 70 subjects undergoing non-emergent orthopedic surgery of the knee (n = 28), hip (n = 35), or spine (n = 7) between August 2011 and November 2011. Plasma was collected preoperatively (T1), 1-h intraoperatively (T2), 1-h (T3), 24-h (T4) and 48-h (T5) postoperatively. Platelet function testing was performed using whole blood impedance aggregometry. Coagulation assays were performed for factor VII, factor VIII, von Willebrand Factor (vWF), and fibrinogen. Of the 70 patients, mean age was 64.1 ± 9.8 years, 61 % were female, and 74 % were Caucasian. Platelet activity decreased until 1 h postoperatively and then significantly increased above baseline at 24- and 48-h postoperatively. Compared to baseline, coagulation factors decreased intraoperatively. Factor VII activity continued to decrease, while FVIII, vWF, and fibrinogen all increased above baseline postoperatively. The results of our study indicate significant changes in platelet activity and coagulation factors during the perioperative period. Both platelet activity and markers of coagulation decrease during the intraoperative period and then some increase postoperatively. These changes may contribute to the hypercoagulabity and/or bleeding risk that occurs in the perioperative period. Future prospective studies aimed at correlating hemostatic changes with perioperative outcomes are warranted.

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Acknowledgments

Data analysis and statistical support was provided by New York University School of Medicine Cardiovascular Outcomes Group. This study was funded by the New York Cardiac Center (JSB).

Conflict of interest

There are no conflicts of interest for any of the submitting authors.

Author information

Authors and Affiliations

  1. Department of Medicine, New York University Langone Medical Center, 530 First Avenue Skirball 9R, New York, NY, 10016, USA

    Brandon S. Oberweis

  2. Divisions of Cardiology, Hematology and Vascular Surgery, Department of Medicine and Surgery, New York University Langone Medical Center, 530 First Avenue Skirball 9R, New York, NY, 10016, USA

    Jeffrey S. Berger

  3. Department of Anesthesiology, New York University Langone Medical Center, New York, NY, USA

    Germaine Cuff, Andrew Rosenberg, Luis Pardo & Mitchell Marshall

  4. Department of Pediatrics, New York University Langone Medical Center, New York, NY, USA

    Michael A. Nardi

  5. Department of Pathology, New York University Langone Medical Center, New York, NY, USA

    Michael A. Nardi

  6. Department of Population Health, Division of Biostatistics, New York University Langone Medical Center, 530 First Avenue Skirball 9R, New York, NY, 10016, USA

    Yu Guo

  7. Division of Pulmonary and Critical Care, Department of Medicine, New York University Langone Medical Center, New York, NY, USA

    Ezra Dweck & David Steiger

  8. Department of Orthopedic Surgery, New York University Langone Medical Center, New York, NY, USA

    Steven Stuchin

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  1. Brandon S. Oberweis
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  10. Steven Stuchin
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  11. Jeffrey S. Berger
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Corresponding author

Correspondence to Jeffrey S. Berger.

Appendix

Appendix

See Tables 4 and 5.

Table 4 Median preoperative platelet activity according to demographics
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Table 5 Median preoperative coagulation values as a function of baseline demographics
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Oberweis, B.S., Cuff, G., Rosenberg, A. et al. Platelet aggregation and coagulation factors in orthopedic surgery. J Thromb Thrombolysis 38, 430–438 (2014). https://doi.org/10.1007/s11239-014-1078-1

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  • DOI: https://doi.org/10.1007/s11239-014-1078-1

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