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Perioperative autotransfusion and functional coagulation analysis in total hip replacement
G Ekbäck1, U Schött, K Axelsson
1Department of Anesthesiology and Intensive Care, Orebro Medical Center Hospital, Sweden.
Acta Anaesthesiologica Scandinavica
|April 1, 1995
Summary
Functional coagulation analysis using Sonoclot effectively monitored blood changes during autotransfusion in hip replacement surgery. This method showed promise for tailoring plasma substitution and preventing clots in patients undergoing autologous blood transfusions.
Area of Science:
- Anesthesiology
- Transfusion Medicine
- Coagulation Science
Background:
- Perioperative autotransfusion is common in major surgeries like total hip arthroplasty.
- The impact of different transfusion strategies on coagulation during autotransfusion remains incompletely understood.
- Functional coagulation analyses have not been extensively evaluated in this context.
Purpose of the Study:
- To prospectively evaluate functional coagulation analyses, specifically Sonoclot, during perioperative autotransfusion.
- To compare three distinct transfusion regimens in patients undergoing total hip arthroplasty.
- To assess the correlation of Sonoclot findings with routine coagulation tests, blood loss, and dextran dosage.
Main Methods:
- Prospective study of 45 patients undergoing total hip arthroplasty.
- Three transfusion groups: heterologous erythrocyte concentrate, cell-saver autotransfusion, and combined autologous/salvaged blood.
- Sonoclot and routine coagulation analyses performed at multiple time points (preoperative, 6h, days 1-5, day 10).
Main Results:
- Sonoclot detected early postoperative hypocoagulation and late hypercoagulation with signs of platelet dysfunction and fibrin deposition across all groups.
- Sonoclot analysis demonstrated a stronger correlation with blood loss and dextran dosage compared to activated partial thromboplastin time (APTT) and platelet count.
- Functional coagulation analysis provided insights into dynamic coagulation changes not fully captured by routine tests.
Conclusions:
- Functional coagulation analysis, particularly Sonoclot, can effectively monitor coagulation status during perioperative autotransfusion.
- Sonoclot findings correlate better with transfusion-related factors than standard coagulation tests.
- Functional coagulation analysis holds potential for personalizing plasma substitution and thromboprophylaxis strategies in autotransfusion settings for total hip replacement.