Selective pharmacological prophylaxis based on individual risk assessment using plasma levels of soluble fibrin and plasminogen-activator inhibitor-1 following total hip arthroplasty

Abstract

Objectives. The purpose of this prospective study was to evaluate the utility of preferential application of pharmacoprophylaxis based on the quantitative evaluation by soluble fibrin (SF) and plasminogen activator inhibitor-1 (PAI-1) analysis on the day after total hip arthroplasty (THA).

Methods. A hundred and sixteen patients were enrolled. High-risk patients were defined as those with elevated levels of SF or PAI-1, beyond their cut-off values, on the day after THA. For high-risk patients, fondaparinux was administered for 10 days postoperatively. When both plasma levels of SF and PAI-1 were less than their cutoff levels, the patients were regarded to be at low risk. For low-risk patients, only mechanical prophylaxis was applied.

Results. Sixty patients (52%) were considered to be at high risk. Among them, venous thromboembolism (VTE) was detected in five patients (8%) by CT angiography. In addition, there were four patients (3%) who developed bleeding complications. Fifty-six patients (48%) were considered to be at low risk, and only one patient (2%) developed VTE.

Conclusion. The measurement of SF and PAI-1 levels on the day after surgery may be helpful to identify the individual risk for postoperative VTE. According to this evaluation, a half of patients might not need to administer anticoagulant agents following surgery.

Keywords:

• Plasminogen-activator inhibitor-1
• Risk assessment
• Soluble fibrin
• Total hip arthroplasty
• Venous thromboembolism

Acknowledgments

We thank the following people for their contributions: Chie Aoki, Hiroshi Fujimaki, Taro Tezuka, Yasuhide Hirata, Takako Momose, Yushi Miyamae, Haruka Suzuki, Masamitsu Tomioka and Yurika Ata, all the orthopedic surgeons who participated at Yokohama City University.

Funding

This work was supported by Grant-in-Aid for Scientific Research (KAKENHI) from the Ministry of Education, Culture, Sports, Science and Technology (No. 22591666).

Conflict of interest

None.