Luo Xuefeng, Wang Dehua, Xu Wei, Zou Jing, Kang Runxing, Zhang Tao, Liang Xi, Liao Junyi, Huang Wei
Department of Orthopaedic Surgery The First Affiliated Hospital of Chongqing Medical University Chongqing China.
Chongqing Municipal Health Commission Key Laboratory of Musculoskeletal Regeneration and Translational Medicine Orthopaedic Research Laboratory of Chongqing Medical University Chongqing China.
J Exp Orthop. 2024 Oct 30;11(4):e70074. doi: 10.1002/jeo2.70074. eCollection 2024 Oct.
Ecchymosis is one of the most common complications following total knee arthroplasty (TKA), which is closely related to postoperative bleeding. However, it is still controversial whether anticoagulation treatment should be continued for postoperative ecchymosis patients. We suppose that personalized delayed anticoagulation therapy could be beneficial for decreasing postoperative bleeding.
A total of 201 TKA patients were retrospectively included in this study, among whom ecchymosis patients received drug anticoagulation treatment 1-2 days later than usual, while nonecchymosis patients received regular drug anticoagulation treatment. The perioperative blood loss, coagulation state, fibrinolytic state and complications were collected and analyzed.
Eighty-nine patients (44.3%) developed ecchymosis within 3 days after TKA. There were no differences in baseline characteristics between the two groups. In the ecchymosis group, higher K values and lower calculated coagulation index values were observed in thromboelastography, along with greater total blood loss and a more significant decrease in haemoglobin levels on postoperative Day 1 (POD1) compared to the nonecchymosis group. Additionally, the ecchymosis patients exhibited higher levels of fibrinogen degradation products and D-dimer (D-D) on POD1, with no differences noted on POD3, indicating that patients with ecchymosis are in a relatively hypocoagulable and hyperfibrinolytic state compared to those without ecchymosis. Therefore, the delayed anticoagulation treatment proved beneficial for correcting these postoperative conditions. No statistically significant differences were found between the two groups in postoperative complications, demonstrating that delayed anticoagulation treatment is safe.
Patients with ecchymosis exhibited a relatively hypocoagulable and hyperfibrinolytic state with a stronger tendency for postoperative bleeding. Delayed anticoagulation in ecchymosis patients could effectively prevent further exacerbation of postoperative bleeding by avoiding sustained hypocoagulable and hyperfibrinolysis states. Personalized delayed anticoagulation therapy could be beneficial for managing postoperative ecchymosis for TKA patients.
Level IV.
瘀斑是全膝关节置换术（TKA）后最常见的并发症之一，与术后出血密切相关。然而，对于术后出现瘀斑的患者是否应继续进行抗凝治疗仍存在争议。我们推测个性化延迟抗凝治疗可能有助于减少术后出血。
本研究回顾性纳入了201例TKA患者，其中出现瘀斑的患者比平时晚1 - 2天接受药物抗凝治疗，未出现瘀斑的患者接受常规药物抗凝治疗。收集并分析围手术期失血量、凝血状态、纤溶状态及并发症。
89例患者（44.3%）在TKA术后3天内出现瘀斑。两组患者的基线特征无差异。在瘀斑组，血栓弹力图显示K值较高，计算凝血指数值较低，与未出现瘀斑组相比，术后第1天（POD1）总失血量更大，血红蛋白水平下降更显著。此外，瘀斑患者在POD1时纤维蛋白原降解产物和D - 二聚体（D - D）水平较高，在POD3时无差异，表明与未出现瘀斑的患者相比，出现瘀斑的患者处于相对低凝和高纤溶状态。因此，延迟抗凝治疗被证明有助于纠正这些术后情况。两组术后并发症无统计学显著差异。表明延迟抗凝治疗是安全的。
出现瘀斑的患者表现出相对低凝和高纤溶状态，术后出血倾向更强。对出现瘀斑的患者进行延迟抗凝可通过避免持续的低凝和高纤溶状态有效预防术后出血进一步加重。个性化延迟抗凝治疗可能有助于TKA患者术后瘀斑的处理。
四级。
