The Assessment of the Frequency of Complications in the Analysis of the Time Interval between Anticoagulants and Haemostatic Drugs among Patients after the Total Knee and Hip Replacement

In 4,8-10% of cases complications after a total hip and knee replacement (THR and TKR) may develop. Deep vein thrombosis may develop in 3,4-60% of cases, we can use anticoagulants (AC) for the prevention and treatment of thrombosis. Blood loss may be 20-40% of the volume of blood circulation, we can use haemostatic drugs (HD) to correct blood loss. AC and HD have multidirectional effects so a combined use of them can lower their effectiveness, this also may influence the frequency of postoperative complications. That is why we should assess the time interval (TI) between AC and HD.

We have performed a retrospective study using the data of 93 medical patients, who received treatment in the 2017 year on the base of Rostov State Medical University. The age range of patients was from 40 to 82 years old. All the patients had undergone THR and TKR and received AC and HD.

Tranexamic acid (TA) was the most often prescribed of HD - 51 (54,84%) patients. TA retains its the antifibrinolytic concentration in different tissues about 17 hours, in the blood plasma - 7-8 hours, according to the register of medicines of Russia. Enoxaparin-natrium and dabigatran were the most often prescribed drugs of AC - 31 (33,33%) patients. All the patients were ranked according to groups of the TI between the last prescription of HD and the first prescription of AC. The TI of the first group (57; 61,3% of patients) was ≤ 17 hours. The TI of the second group (36; 38,7% of patients) was ≥ 18 hours. In the first group 5 (5,38%) patients had the postoperative complications: 1 (1,08%) patient had an ischemic stroke, the TI was 7 hours; 2 (2,15%) patients had a haematoma of a postoperative wound, the TI were 16 and 17 hours, 2 (2,15%) patients had a deep vein thrombosis, the TI was 16 hours. In the second group 1 (1,08%) patient had the deep vein thrombosis after THR and TKR, the TI was 19 hours.

The study showed that the TI between AC and HD 61% of patients was less than 17 hours. 6,45% of patients had thrombohaemorrhagic complications. The TI of 16 hours had the postoperative complications most often.