ANALYSIS OF RISK FACTORS AND ASSESSMENT OF PREVENTION OF VENOUS THROMBOEMBOLIC COMPLICATIONS IN PATIENTS WITH HIP JOINT REPLACEMENT

Abstract

The issue of thromboembolic complications prevention is one of great importance, since patients have a high risk of developing postoperative venous thromboembolism. Objective. To analyze risk factors contributing to the development of venous thromboembolic complications in patients with hip pathology undergoing arthroplasty, and to substantiate its prophylactic measures. Methods. Depending on age, all patients were divided into groups: 20–40 years  — 13 individuals, 41–60 years — 13 individuals, 61– 80 years — 42 cases. To assess the effectiveness of thromboprophylaxis, two groups of patients diagnosed with stage III–IV idiopathic coxarthrosis aged 41 to 80 years were compared. 100 patients with various pathologies of the hip who underwent surgical treatment with endoprosthetics were involved. Results. Among the identified nosological forms of pathology, idiopathic coxarthrosis was most frequently diagnosed in patients aged 41 to 80 years. Our study demonstrated dynamic changes in the hemostatic system in patients after total hip arthroplasty when using various drugs for the prevention of thromboembolic complications, taking into account the level of antithrombin-III. In patients of the group I who received nadroparin calcium, the fibrinogen content in the blood before the operation was 4.90 (4.50–5.10) g/l, after 7 days — 4.40 (4.30–4.65), after 14 — 3.54 (2.30–3.75) g/l. In group II, thromboprophylaxis was achieved by taking dabigatran etexilate, before the operation, the fibrinogen content in the blood was 4.87 (4.45–5.15) g/l, after 7 days — 4.30 (4.20–4.50), after 14 — 3.62 (2.35–3.80) g/l. Conclusions. In patients with hip pathology, the main risk factors for venous thromboembolic complications before the endoprosthetic surgery and in the early postoperative period are age 41-80 years, obesity, arterial hypertension, as well as chronic venous insufficiency of the lower extremities. Thromboprophylaxis in total hip arthroplasty should be implemented with an individualized approach, considering not only surgical factors but also the early postoperative period.