Effect Of Acute Non-isovolemic Hemodilution On Perioperative Platelet Activation In Elderly Patients Undergoing Total Hip Arthroplasty

Background and significanceArtificial total hip arthroplasty is a new orthopedic surgery which develops rapidly in recent years, It can effectively alleviate old patients’ pain and improve the body function, improve the quality of life. But the total hip arthroplasty can get more trauma, hemorrhage, and the elderly physiological hypofunction or suffer from high blood viscosity. They are easy to be complicated by deep vein thrombosis(deep vein thrombosis, DVT). So it is very urgent to understand the mechanism of thrombosis and to have an active prevention and treatment of thrombotic diseases. Thrombosis is involved in vascular endothelial cells, platelets, and clotting navigation coagulation, fibrinolytic navigation and so on. In many links, platelet activation, adhesion and aggregation in early physiological hemostasis or pathological plays an important role in the process of thrombosis. In recent years, the main molecular markers of platelet activation release PAC-1, CD62P attracts more and more attention.. For reducing the occurrence of complications such as allogeneic blood transfusion and prevent DVT, the measures such as acute non-isovolemic hemodilution (ANIH) have been widely used in clinical. But the laboratory studies are mostly on the bleeding in patients with surgery, losing blood, blood rheology and blood coagulation function of conventional index observation. It is a lack of blood coagulation and fibrinolysis system comprehensive dynamic observation. It is also lack of research on the particularity of elderly patients. The effect of platelet activation function is reported less. The study intends to dynamic observation ANIH for elderly patients with total hip arthroplasty perioperative blood platelet activation markers of PAC-1, CD62P and coagulation function indexes of two D dimer (DD), to explore ANIH for prevention of elderly patients with total hip replacement perioperative thrombosis. It also provide evidence for early diagnosis and treatment for elderly patients with total hip arthroplasty perioperative thrombosis.ObjectiveTo observe the effects of acute non-isovolemic hemodilution (ANIH) on the levels of PAC-1, CD62P, DD and platelet in elderly patients undergoing total hip arthroplasty.Methods40elderly patients undergoing total hip arthroplasty were randomly divided into ANIH group and control group;the changes of PAC-1and CD62P at the times of before induction of anesthesia,30min after ANIH, end of operation, one day and three days after operation were examined by flow cytometry respectively. The levels of DD at different time were examined by ACL-TOP.ResultsThere were no differences between ANIH group and control group in the levels of PAC-1, CD62P, PLT and DD at the time of before induction of anesthesia (t<0.5, P>0.05). The levels of PAC-1and CD62P were lower at the time of before induction of anesthesia,30min after ANIH, end of operation and one day after operation (t>2.5, P<0.05) as compared with those of control group. At the time of three days after operation, the level of PAC-1was lower (t=2.77, P<0.05), and the level of CD62P was lower too(t=0.73, P>0.05),but the level of PLT was higher (t=2.68, P<0.05). Moreover, the level of DD was lower at the time of one day and three days after operation (t=11.12、11.67, P<0.05). The levels of PAC-1and PLT were decreased at the time of30min after ANIH as compared with those of before induction of anesthesia in ANIH groups (t=2.27、19.30, P<0.05), and the levels of CD62P and DD were increased (t=10.28、8.11,P<0.05); The levels of PAC-1, CD62P, PLT and DD were all increased (t=4.31、5.86、18.26、19.70, P<0.05) at the time of end of operation. However, the levels of PAC-1, CD62P, PLT and DD were all decreased (t=2.82、5.12、13.26、15.37,P<0.05) at the time of one day after operation. The levels of PAC-land DD were decreased at the time of three days after operation (t=2.15、13.30, P<0.05), and the level of CD62P was decreased, but the difference were not significant(t=1.27, P>0.05), and the level of PLT was increased (r=14.67, P<0.05).ConclusionsANIH inhibit over-activation of platelet during perioperative period for elderly patients undergoing total hip arthroplasty and prevent deep vein thrombosis.