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Dailiana ZH, Stefanou N, Varitimids S, Rigopoulos N, Dimitroulias A, Karachalios T, Malizos KN, Kyriakou D, Kollia P. Factors predisposing to thrombosis after major joint arthroplasty. World J Orthop 2020; 11:400-410. [PMID: 32999860 PMCID: PMC7507077 DOI: 10.5312/wjo.v11.i9.400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 07/16/2020] [Accepted: 08/01/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Total joint arthroplasty is one of the most common options for end stage osteoarthritis of major joints. However, we must take into account that thrombosis after hip/knee arthroplasty may be related to mutations in genes encoding for blood coagulation factors and immune reactions to anticoagulants [heparin-induced thrombocytopenia (HIT)/thrombosis]. Identifying and characterizing genetic risk should help to develop diagnostic strategies or modify anticoagulant options in the search for etiological mechanisms that cause thrombophilia following major orthopedic surgery.
AIM To evaluate the impact of patients’ coagulation profiles and to study specific pharmacologic factors in the development of post-arthroplasty thrombosis.
METHODS In 212 (51 male and 161 female) patients that underwent primary total hip arthroplasty (100) or total knee arthroplasty (112) due to osteoarthritis during a period of 1 year, platelet counts and anti-platelet factor 4 (PF4)/heparin antibodies were evaluated pre/postoperatively, and antithrombin III, methylenetetrahydrofolate reductase, factor V and prothrombin gene mutations were evaluated preoperatively. In a minimum follow-up of 3 years, 196 patients receiving either low-molecular-weight heparins (173) or fondaparinux (23) were monitored for the development of thrombocytopenia, anti-PF4/heparin antibodies, HIT, and thrombosis.
RESULTS Of 196 patients, 32 developed thrombocytopenia (nonsignificant correlation between anticoagulant type and thrombocytopenia, P = 0134.) and 18 developed anti-PF4/heparin antibodies (12/173 for low-molecular-weight heparins and 6/23 for fondaparinux; significant correlation between anticoagulant type and appearance of antibodies, P = 0.005). Odds of antibody emergence: 8.2% greater in patients receiving fondaparinux than low-molecular-weight heparins. Gene mutations in factor II or V (two heterozygotes for both factor V and II) were identified in 15 of 196 patients. Abnormal low protein C and/or S levels were found in 3 of 196 (1.5%) patients, while all patients had normal levels of von Willebrand factor, lupus anticoagulant, and antithrombin III. Four patients developed HIT (insignificant correlation between thrombocytopenia and antibodies) and five developed thrombosis (two had positive antibodies and two were heterozygotes for both factor II & V mutations). Thrombosis was not significantly correlated to platelet counts or HIT. The correlation of thrombosis to antibodies, factor II, factor V was P = 0.076, P = 0.043, P = 0.013, respectively.
CONCLUSION Screening of coagulation profile, instead of platelet monitoring, is probably the safest way to minimize the risk of post-arthroplasty thrombosis. In addition, fondaparinux can lead to the formation of anti-PF4/heparin antibodies or HIT.
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Affiliation(s)
- Zoe H Dailiana
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Nikolaos Stefanou
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Sokratis Varitimids
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Nikolaos Rigopoulos
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Apostolos Dimitroulias
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Theofilos Karachalios
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Konstantinos N Malizos
- Department of Orthopaedic Surgery, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Despoina Kyriakou
- Laboratory of Haematology - Transfusion Medicine, Faculty of Medicine, School of Health Sciences, University of Thessaly, Larissa 41500, Greece
| | - Panagoula Kollia
- Department of Human Genetics, Faculty of Biology, National and Kapodistrian University of Athens, Athens 11635, Greece
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Young G, Albisetti M, Bonduel M, Brandao L, Chan A, Friedrichs F, Goldenberg NA, Grabowski E, Heller C, Journeycake J, Kenet G, Krümpel A, Kurnik K, Lubetsky A, Male C, Manco-Johnson M, Mathew P, Monagle P, van Ommen H, Simioni P, Svirin P, Tormene D, Nowak-Göttl U. Impact of Inherited Thrombophilia on Venous Thromboembolism in Children. Circulation 2008; 118:1373-82. [DOI: 10.1161/circulationaha.108.789008] [Citation(s) in RCA: 206] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background—
The aim of the present study was to estimate the impact of inherited thrombophilia (IT) on the risk of venous thromboembolism (VTE) onset and recurrence in children by a meta-analysis of published observational studies.
Methods and Results—
A systematic search of electronic databases (Medline, EMBASE, OVID, Web of Science, The Cochrane Library) for studies published from 1970 to 2007 was conducted using key words in combination as both MeSH terms and text words. Citations were independently screened by 2 authors, and those meeting the inclusion criteria defined a priori were retained. Data on year of publication, study design, country of origin, number of patients/controls, ethnicity, VTE type, and frequency of recurrence were abstracted. Heterogeneity across studies was evaluated, and summary odds ratios and 95% CIs were calculated with both fixed-effects and random-effects models. Thirty-five of 50 studies met inclusion criteria. No significant heterogeneity was discerned across studies. Although >70% of patients had at least 1 clinical risk factor for VTE, a statistically significant association with VTE onset was demonstrated for each IT trait evaluated (and for combined IT traits), with summary odds ratios ranging from 2.63 (95% CI, 1.61 to 4.29) for the factor II variant to 9.44 (95% CI, 3.34 to 26.66) for antithrombin deficiency. Furthermore, a significant association with recurrent VTE was found for all IT traits except the factor V variant and elevated lipoprotein(a).
Conclusions—
The present meta-analysis indicates that detection of IT is clinically meaningful in children with, or at risk for, VTE and underscores the importance of pediatric thrombophilia screening programs.
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Affiliation(s)
- Guy Young
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Manuela Albisetti
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Mariana Bonduel
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Leonardo Brandao
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Anthony Chan
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Frauke Friedrichs
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Neil A. Goldenberg
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Eric Grabowski
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Christine Heller
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Janna Journeycake
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Gili Kenet
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Anne Krümpel
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Karin Kurnik
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Aaron Lubetsky
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Christoph Male
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Marilyn Manco-Johnson
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Prasad Mathew
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Paul Monagle
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Heleen van Ommen
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Paolo Simioni
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Pavel Svirin
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Daniela Tormene
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
| | - Ulrike Nowak-Göttl
- From the Division of Hematology/Oncology, Children’s Hospital Los Angeles, Los Angeles, Calif (G.Y.); Division of Hematology, University Children’s Hospital, Zurich, Switzerland (M.A.); Servicio de Hematolgía y Oncología, Hospital de Pediatría “Prof. Dr. J.P. Garrahan,” Buenos Aires, Argentina (M.B.); Hospital for Sick Children, Toronto, Canada (L.B.); McMaster University, Hamilton, Canada (A.C.); Leibniz Institute for Arteriosclerosis Research, University of Münster, Münster, Germany (F.F.)
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