THE DYNAMICS OF PLATELET COUNT AFTER HIP JOINT ARTHROPLASTY
About the author:
Kolomachenko V. I.
CLINICAL AND EXPERIMENTAL MEDICINE
Type of article:
Patients undergoing hip joint arthroplasty are at high risk of perioperative thromboembolic events. There is considerable debate regarding the ideal agent for venous thromboembolism prophylaxis. Administration of aspirin may be a viable option as it appears to be rather effective and is associated with a lower rate of complications. Changes in the blood platelet count could help in prediction of the thromboembolic events. The aim of our studywas to observe the platelet count during perioperative period in patients undergone total hip arthroplasty. We analysed also the dynamics of platelet count in relation to intraoperative anaesthesia and postoperative analgesia techniques, pathology type and patients’ gender. Object and methods. 136 patients (male/female=52/84) 64,2 ± 13,7 years-old undergone primary total hip joint replacement due to coxarthrosis (n=72) or fracture (n= 64) were included in the study. Four variants of intraoperative anaesthesia techniques were used: spinal anaesthesia (n = 68), general anaesthesia (n = 21), paravertebral block in combination with caudal epidural anaesthesia (n = 27), and peripheral nerve blocks (n = 20). Postoperatively three variants of analgesia were administered: systemic opioids (n = 64), paravertebral block (n = 51), and epidural analgesia (n = 21). The platelet count was assessed preoperatively and on postoperative days 1, 3, and 7. All patients received prophylactic doses of low molecular weight heparins, non-steroid-antiinflammatory drugs and paracetamol. Unpaired t-test was used for comparing intergroup difference, and paired t-test – for analysing the difference between stages. P < 0.05 was considered significant. The results are given as mean ± standard deviation. Results and discussion. The preoperative platelet count (mean ± standard deviation) among all patients was 218,7 ± 66,1Ч10 9 /L. It significantly decreased to 202,8 ± 57,8Ч10 9 /L (p = 0,0008 vs initial) on the postoperative day 1 and to 191,4 ± 58,9Ч10 9 /L (p < 0,0001 vs initial) on the postoperative day 3. On the postoperative day 7 we detected a significant increase in platelet count up to 334,6 ± 94,5Ч10 9/L (p < 0,0001 vs initial). The same dynamics of platelet count was seen in all groups according to intraoperative anaesthesia and postoperative analgesia techniques. In all groups there was seen the moderate decrease in platelet count, but all dates were in normal reference borders. On the seventh postoperative day the platelet count increased in all groups above the normal reference level 300-450Ч10 9 /L (p < 0,001 vs initial). The highest level of platelet count was detected in patients operated under general anaesthesia compared to spinal anaesthesia and paravertebral+caudal epidural blocks. The dynamics of platelet count were the same in three groups of postoperative analgesia techniques. Among these three variants of postoperative analgesia techniques the systemic administration of opioids was associated with the highest platelet count – 362Ч10 9 /L. There was no significant difference in dynamics of platelet count between the patient groups operated due to coxarthrosis and fractures in hip joint. Also we did not find the gender differences in platelet count at any stage of study. Conclusions. After total hip arthroplasty the patients have moderately decreased platelet count during the first three postoperative days and significantly elevated platelet count on the seventh postoperative day. The highest platelet count on the seventh postoperative day seen in patients operated under general anaesthesia and giving systemic opioids postoperatively, compared to regional methods of anaesthesia and analgesia. The platelet count dynamics are not dependent on pathology type (coxarthrosis or fracture) and gender.
hip joint arthroplasty, platelet count, anaesthesia, analgesia
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Publication of the article:
«Bulletin of problems biology and medicine» Issue 1 Part 1 (142), 2018 year, 124-130 pages, index UDK 617.728.2 – 089.844 – 085.212 – 008.852 – 072.5