Increased fibrinolysis increases bleeding in orthopedic patients receiving prophylactic fondaparinux

• Published in: International journal of hematology Vol. 95; no. 2; pp. 160 - 166
• Main Authors: Yoshida, Kakunoshin, Wada, Hideo, Hasegawa, Masahiro, Wakabayashi, Hiroki, Matsumoto, Takeshi, Shimokariya, Yuji, Noma, Katsura, Yamada, Norikazu, Uchida, Atsumasa, Nobori, Tsutomu, Sudo, Akihiro
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01-02-2012; Springer; Springer Nature B.V
• Subjects: Aged; Anticoagulants - administration & dosage; Anticoagulants - adverse effects; Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Biological and medical sciences; Biomarkers - blood; Blood and lymphatic vessels; Cardiology. Vascular system; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous; Factor Xa Inhibitors; Female; Fibrin - metabolism; Fibrin Fibrinogen Degradation Products - metabolism; Fibrinogen - metabolism; Fibrinolysis - drug effects; Fibrinolysis - physiology; Hematologic and hematopoietic diseases; Hematology; Hemorrhage - blood; Hemorrhage - chemically induced; Humans; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Oncology; Original Article; Polysaccharides - administration & dosage; Polysaccharides - adverse effects; Postoperative Complications - blood; Postoperative Complications - prevention & control; Venous Thrombosis - blood; Venous Thrombosis - prevention & control; Deep vein thrombosis (DVT); Orthopedic surgery; Fibrinolysis; Bleeding; Fondaparinux; Human; Serine endopeptidases; Hematology; Enzyme; Enzyme inhibitor; Deep vein thrombosis; Cardiovascular disease; Coagulation Factor Xa; Hemorrhage; Fondaparinux sodium; Venous disease; Vascular disease; Prevention; Peptidases; Treatment; Pentasaccharide; Antithrombotic agent; Hydrolases; Venous thrombosis
• ISSN: 0925-5710; 1865-3774
• DOI: 10.1007/s12185-012-1004-2

We evaluated hemostatic markers in patients who underwent major orthopedic surgery, including total hip and total knee arthroplasty, and were treated for the prophylaxis of deep vein thrombosis (DVT) with or without fondaparinux (anti-Xa group,
n
 = 98 and without anti-Xa group,
n
 = 20). The frequency of DVT was significantly higher in the without anti-Xa group than in the anti-Xa group, but the reduction of hemoglobin and fibrinolytic marker levels was significantly lower in the without anti-Xa group than in the anti-Xa group. Eighteen patients in the anti-Xa group showed a reduction in hemoglobin of more than 2 g/dl, and those individuals were considered to be the increased bleeding (IB) group. The concentration of fibrinolytic markers in the anti-Xa group was significantly higher in the IB group than in the non-IB group. There were also no significant differences in the levels of anti-Xa activity, plasminogen activator inhibitor-I, soluble fibrin and antithrombin between the IB and non-IB groups. In conclusion, elevated fibrinolysis induced by increased bleeding may lead to further increases in bleeding in patients receiving thromboprophylaxis with fondaparinux following major orthopedic surgery.