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October 1, 1989Acta Anaesthesiologica Scandinavica

Coagulation and fibrinolytic parameters in patients undergoing total hip replacement: influence of the anaesthesia technique

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Why the study?

Does epidural anaesthesia improve coagulation and fibrinolytic parameters compared to general anaesthesia in patients undergoing total hip replacement?

Population

80 patients undergoing total hip replacement (THR)

Comparison

Epidural anaesthesia or combined epidural and… vs General anaesthesia (n=29)

Design

RCT, randomly allocated to three groups

Follow-up

7 days postoperatively

Authors

RDR DonadoniGhent University HospitalGBGuy BaeleRega Institute for Medical ResearchJDJacques DevulderGhent University Hospital

Discussion

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Implication

Supports epidural anaesthesia to potentially reduce thromboembolic risk after hip replacement; extends RCT evidence on coagulation benefits.

Key Points

  • To assess how different anesthesia techniques affect coagulation and fibrinolytic profiles in patients undergoing total hip replacement.
  • Randomized trial of 80 patients undergoing total hip replacement allocated to general anesthesia (n = 29), epidural anesthesia (n = 29), or combined epidural and low-dose isoflurane general anesthesia (n = 22).
  • Measured 11 coagulation and fibrinolytic markers, including antithrombin III, PT, APTT, and tissue plasminogen activator, across four timepoints: pre-induction, end of surgery, postoperative day 1 morning, and postoperative day 7.
  • Antithrombin III levels decreased equally across all three groups immediately following surgery.
  • Antithrombin III recovered significantly faster in the epidural group by the first postoperative morning, reaching a mean of 104.1% compared to 96.2% in the general anesthesia group and 92.7% in the combined anesthesia group.

Structured PICO

Does epidural anaesthesia improve coagulation and fibrinolytic parameters compared to general anaesthesia in patients undergoing total hip replacement?

P
Population
80 patients undergoing total hip replacement (THR)
I
Intervention
Epidural anaesthesia (n=29) or combined epidural and general anaesthesia with lower isoflurane concentration (n=22)
C
Comparator
General anaesthesia (n=29)
O
Outcome
Coagulation and fibrinolytic parameters (PT, APTT, FG, PG, AT III, Proc C, alpha 2AP, F VIII:C, vWF:Ag, vWF:Rcof, tPA antigen and activity) measured before induction, at the end of surgery, on the first postoperative morning, and 7 days postoperativelysurrogate

Epidural anaesthesia promotes a faster recovery of antithrombin III levels postoperatively, which may contribute to its beneficial effect in preventing thromboembolic complications after total hip replacement.

Cite This Study

Donadoni et al. (1989) studied this question.

synapsesocial.com/papers/6a8ce38d0fc8325511ff1632https://doi.org/10.1111/j.1399-6576.1989.tb02972.x
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1The effect of total hip replacement and general surgery on antithrombin III in relation to venous thrombosis.1979 · 68 citations
  2. 2Protein C Antigen Levels in Major Abdominal Surgery: Relationships to Deep Vein Thrombosis, Malignancy and Treatment with Stanozolol1985 · 21 citations
  3. 3Trauma, Stress and Immunity in Anaesthesia and Surgery1983 · 63 citations
  4. 4Methods for Determination of Plasmin, Antiplasmin and Plasminogen by Means of Substrate S-22512009 · 301 citations
  5. 5Effect of Dextran on Fibrinolysis Inhibition Activity in the Blood after Major Surgery1980 · 25 citations