The Perioperative von Willebrand Factor Activity and Factor VIII Levels Among Alcohol Use Disorder Patients Undergoing Total Knee or Hip Replacement

Abstract

Alcohol use disorder patients have a five-fold higher risk of postoperative bleeding complications. We measured the perioperative von Willebrand factor and factor VIII levels in consecutive patients with alcohol use disorder. In one university hospital, 105 patients scheduled for arthroplasty were screened, and 25 fulfilled inclusion criteria. Postoperatively, we found significantly decreased von Willebrand factor ristocetin cofactor values over time among alcohol use disorder patients and significantly different time courses of factor VIII levels between patients with and without a diagnosed alcohol use disorder. Blood loss was significantly increased among alcohol use disorder patients on their first postoperative day.

RÉSUMÉ

Mesures périopératoires des taux de facteur von Willebrand et de facteur VIII chez des patients consommant excessivement de l´alcool subissant un remplacement total du genou ou de la hanche

Les patients consommant trop d´alcool présentent un risque 5 fois plus élevé de souffrir de saignements periopératoires. Nous avons mesuré les taux des facteurs von Willebrand et de facteur VIII chez des patients consommant excessivement de l´alcool. Dans un hôpital universitaire, sur 105 patients devant subir une arthoplastie, 25 ont rempli les critères d´inclusion. Après avoir subi l´opération, nous avons observé chez ces patients une diminution du facteur von Willebrand et du cofacteur ristocétine au cours du temps. Nous avons également mesuré des cinétiques de facteur VIII différentes entre les patients consommant ou non excessivement de l´alcool. De plus, les pertes de sang étaient significativement plus élevées chez les patients à forte consommation d´alcool au premier jour post-opératoire.

RESUMEN

Actividad del factor von Willebrand y niveles de factor VIII postoperatorios en pacientes con consumo peligroso de alcohol sometidos a remplazamiento total de rodilla o cadera

Pacientes afectados por el consumo de alcohol tienen un riesgo cinco veces superior de sufrir complicaciones hemorrágicas postoperatorias. Nosotros medimos los niveles perioperatorios de factor von Willebrand y factor VIII en pacientes con consumo peligroso de alcohol. En un hospital universitario se hizo un cribaje de 105 pacientes programados para artroplastia y 25 cumplían los criterios de inclusión. Postoperatoriamente encontramos valores significativamente disminuidos del cofactor ristocetina del factor von Willebrand a lo largo del tiempo en pacientes con consumo peligroso de alcohol y cursos cronológicos significativamente differentes de los niveles de factor VIII entre los pacientes con y sin consumo peligroso de alcohol. La pérdida de sangre en el primer dia postoperatorio fue significativamente mayor en los pacientes con consumo de alcohol.

Keywords :

• factor VIII
• von Willebrand factor
• alcohol use disorder
• knee replacement
• hip replacement
• bleeding complication
• public health
• hazardous alcohol consumption

THE AUTHORS

Helge Schoenfeld, MD, is an anesthesiologist in the department of anesthesiology and intensive care medicine at the University Hospital Charité—Universitaetsmedizin Berlin. One focus of his research is the reduction of perioperative risks of patients, especially bleeding complications. His research interests include risk management of patients with hazardous alcohol consumption undergoing surgery, perioperative hemostasis, and transfusion medicine.

Carsten F. Perka, MD, PhD, professor of orthopedics, is deputy director of the center for musculoskeletal surgery and chairman of the orthopaedic department in the Center for Muskuloskeletal Surgery in the University Hospital Charité—Universitaetsmedizin Berlin. He is the organizer for national and international operative technique courses for hip and knee endoprosthetic surgery (triannually). Prof. Perka currently is principal investigator and coinvestigator in more than 20 clinical trials. He has published more than 100 articles and book chapters in the fields of orthopedics, tissue engineering, and traumatology.

Sabine Ziemer, MD, is the chief consultant of the Institute of Laboratory Medicine, Charité— Universitaetsmedizin Berlin. She is the head of the hemostaseological laboratory. The focus of her clinical practice and research activity is the wide spectrum of thrombosis and hemostasis, underlying diseases, and risk factors. As a leading international expert for hemostaseology, she is a member of numerous societies in leading or active position, and author and coauthor of more than 70 research articles and book chapters

Ranja Hübner, MD, internist, specialises in gastroenterology. The focus of her research is alcohol use and misuse in correlation with bleeding diseases/complications. She is interested in alcohol and cancer research.

Tania Schink, PhD, MPH is attending numerous clinical and experimental studies in her capacity as a statistician. She is author and co-author of more than 25 research publications.

Bruno Neuner, MD, MSE, epidemiologist, is senior researcher in the field of health promotion with special interest in salutogenic approaches.

Claudia D. Spies, MD, is a professor of anesthesiology and intensive care medicine. In 2005 she became chair of the department of anesthesiology and intenisve care medicine at the Charité—Universitaetsmedizin Berlin Campus Mitte and Campus Virchow. She is responsible for 200 anesthesiologists taking care of approximately 50,000 anesthesias per year, five interdisciplinary ICUs, and two pain clinics. Her research focuses on perioperative risk reduction in patients undergoing surgery, especially addiction behavior associated risks. She is the head of an addiction research team in her department and is a principal investigator in numerous clinical and experimental studies. Prof. Spies is the author of more than 200 research and review articles, and book chapters in the field of alcohol research, anesthesiology, and intensive care medicine.