Platelet aggregation and coagulation factors in orthopedic surgery

Area of Science:

• Anesthesiology and Perioperative Medicine
• Hematology
• Surgical Research

Background:

• Hemostasis is critical during surgery, with altered platelet aggregation and coagulation factors potentially influencing thrombosis and bleeding risks.
• Understanding perioperative hemostatic changes is crucial for managing patient safety.

Purpose of the Study:

• To investigate dynamic changes in platelet aggregation and specific coagulation factors (Factor VII, Factor VIII, von Willebrand Factor, fibrinogen) during the perioperative period.
• To elucidate the hemostatic balance shifts that may contribute to perioperative complications.

Main Methods:

• Prospective cohort study of 70 patients undergoing non-emergent orthopedic surgery (knee, hip, spine).
• Plasma samples collected at five time points: preoperatively, intraoperatively, and 1, 24, and 48 hours postoperatively.
• Assessed platelet function using whole blood impedance aggregometry and measured coagulation factors (FVII, FVIII, vWF, fibrinogen).

Main Results:

• Platelet activity decreased intraoperatively, then significantly increased above baseline at 24 and 48 hours postoperatively.
• Coagulation factors decreased intraoperatively; Factor VII activity continued to decline, while FVIII, vWF, and fibrinogen levels rose postoperatively.
• Observed significant perioperative alterations in both platelet function and coagulation factor levels.

Conclusions:

• Significant changes in platelet activity and coagulation factors occur during the perioperative period.
• These hemostatic shifts, characterized by intraoperative decreases and postoperative increases in certain markers, may underlie perioperative hypercoagulability or bleeding risks.
• Further research correlating these hemostatic changes with clinical outcomes is warranted.