Perioperative blood management combined with Bazhen Tang improves hemoglobin and hypercoagulability in senile patients after joint replacement

doi:10.3969/j.issn.2095-4344.2016.53.003

Abstract

Abstract:

BACKGROUND: Perioperative blood management has been extensively used in orthopedic clinic. However, how the combination of traditional Chinese medicine and perioperative blood management influences the blood biochemical indexes and hypercoagulability after major operation is rarely reported.

OBJECTIVE: To evaluate the effects of the perioperative blood management combined with Bazhen Tang on hemoglobin and hypercoagulability in senile patients after joint replacement.

METHODS: 160 patients undergoing hip or knee artificial joint replacement were enrolled, including 59 cases of total hip replacement and 91 cases of total knee arthroplasty. All patients according to gender, age and disease were equivalently randomized into experimental group (56 cases of primary unilateral joint replacement and 24 cases of bilateral first stage replacement and hip-knee reversion) and control group (54 cases of primary unilateral joint replacement and 26 cases of bilateral first stage replacement and hip-knee reversion). The experimental group patients were given appropriate Bazhen Tang at preoperative 5 days, and those controls received no intervention. All cases were treated with rivaroxaban (anticoagulation) and tranexamic acid (hemostasis) after replacement. The contents of hemoglobin, D-dimer, platelet and fibrinogen in the peripheral blood were recorded at postoperative 3, 7 and 14 days; the amount of postoperative blood loss was recorded, and the incidence rates of deep venous thrombosis and pulmonary embolism after replacement were observed by color Doppler ultrasound.

RESULTS AND CONCLUSION: (1) After unilateral replacement, one case in the control group underwent allogenetic blood transfusion. After bilateral reversion, both two groups underwent allogenetic blood transfusion, but the amount of transfused blood in the experimental group was less than that in the control group (P < 0.000). (2) Hemoglobin was significantly increased in the experimental group compared with the control groups at postoperative 7 and 14 days after bilateral reversion (P=0.012, 0.003). (3) At postoperative 3 and 7 days, the D-dimer content was obviously declined in the experimental group compared with the control group, and there were significant differences in platelet and fibrinogen contents between groups (P=0.010, 0.017, 0.014). After replacement, there were 9 cases of deep venous thrombosis and none of pulmonary embolism in the experimental group; 19 cases of deep venous thrombosis and 2 cases of pulmonary embolism (treated in respiratory ICU) in the control group, and the incidence of complication showed significant difference between groups (P < 0.001). (5) These results suggest that the combination of Bazhen Tang and perioperative blood management can decrease bleeding in senile patients after joint replacement, promote the hemoglobin rising after bilateral replacement or reversion, and improve the hypercoagulability by reduction in the D-dimer and fibrinogen contents, thus cutting down the incidence of deep venous thrombosis and pulmonary embolism.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: Drugs, Chinese Herbal, Hemoglobins, Aged, Blood Platelets, Venous Thrombosis, Tissue Engineering

CLC Number:

R318

Song Yu-cheng, Deng Ying-jie, Liu Zhen-feng, Liang Zhi-quan, Liao Jun, Hong Han-gang, Fang Rui . Perioperative blood management combined with Bazhen Tang improves hemoglobin and hypercoagulability in senile patients after joint replacement[J]. Chinese Journal of Tissue Engineering Research, 2016, 20(53): 7925-7931.

Figures/Tables 3

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