The perioperative risk of deep vein thrombosis and individualized anti-coagulation treatment in patients with hepatic cirrhosis undergoing total hip arthroplasty: a pilot study

Objective To investigate the perioperative risk of deep vein thrombosis(DVT) in patients with hepatic cirrhosis that underwent total hip arthroplasty(THA), and to evaluate the safety and feasibility of individualized anti-coagulation treatment. Methods There were 25 patients complicating hepatic cirrhosis that underwent THA(from Jan. to Dec. 2014), including 17 males and 8 females, aged 57.9±9.2 years. The primary causes of THA were avascular necrosis of the femoral head(eighteen cases) and osteoarthritis of the hip(seven cases). Low molecular weight heparin(LMWH) was applied for anti-coagulation treatment. Parameters of hepatic function and coagulation function of THA cases(randomized thirty cases, from Jan. 2008 to Dec. 2008) without hepatic cirrhosis were used as reference for monitoring. For the cases of massive blood loss or upper gastrointestinal hemorrhage, a LMWH administration pause and an administration of fresh frozen plasma and clotting factors were performed in order to maintain a hemorrage/coagulation balance. The clinical outcome of the hip joint was evaluated and complications were treated. A subsequent follow-up was also carried out after perioperative period. Results All cases received successful surgeries and followed up. The follow-up duration was 34±15.7 months. The preoperative Harris hip score was 32.4±10.2 points, while the most recent follow-up score was 82.9±6.1 points, which was statistically significant. Dislocation, periprosthetic fracture and periprosthetic infection were absent. All cases received individualized anti-coagulation treatments during peripoerative period. A hemorrage/coagulation balance was achieved. The dynamic parameter curves did not present excessive deviation from reference. One case encountered intermuscular hematoma of the lower limbs 48 hours postoperatively, which was solved by a LMWH pause and administration of fresh frozen plasma and clotting factors. One case suffered upper gastrointestinal hemorrhage five days postoperatively, which was controlled by a LMWH pause and the administration of somatostatin and proton pump inhibitor. Jaundic got worse in one case three days postoperatively but got relieved after treatment. Overt blood loss was 686±141.8 ml. Perioperative death, hepatic failure, hepatic encephalopath, hepatorenal syndrome were absent. No DVT was observed. Conclusion There are risks of DVT in patients of hepatic cirrhosis. Individualized anti-coagulation treatment is needed during perioperative period of THA. Key words: Arthroplasty, replacement, hip; Liver cirrhosis; Venous thrombosis; Heparin, low-molecular-weight