Soluble Thrombomodulin and Major Orthopedic Surgery

Irina P. Antropova, PhD, ScD¹,²*; Boris G. Yushkov, PhD,ScD ³,"; Evgeny Kobrinsky, PhD^; Anatoliy N. Varaksin, PhD, ScD°

¹Ural State Medical University, Ekaterinburg, Russia; ²Ural Institute of Traumatology and Orthopedics named after V.D. Chaklin, Ekaterinburg, Russia; ³Institute of Immunology and Physiology, the Urals Branch of the RAS, Ekaterinburg, Russia; "Ural Federal University named after the first President of Russia B.N.Yeltsin, Ekaterinburg, Russia; ^National Institute on Aging, NIH, Baltimore, MD, USA; °Institute of Industrial Ecology, the Urals Branch of the RAS, Ekaterinburg, Russia.

*Corresponding author: Irina Antropova, PhD, ScD. Ural State Medical University, Ural Institute of Traumatology and Orthopedics named after V.D. Chaklin; Ekaterinburg, Russia. E-mail:

Published: September 12, 2016.  DOI: 10.21103/Article6(3)_OA11


Background: A high level of soluble thrombomodulin (sTM) is associated with a lower risk of thrombosis but can cause severe bleeding after operations. Deep vein thrombosis (DVT) and blood loss are serious threats after orthopedic surgery. The aim of our pilot study was to evaluate the effect of the preoperative level of sTM on coagulation and inflammation as well as the blood loss and the development of symptomatic DVT after total large joint replacement.
Methods and Results: In all patients (n=50) who underwent total hip or knee replacement, sTM, PrC, D-dimer, vWF, CRP, and platelets were determined before and after the operation. According to the preoperative sTM level, patients were divided into 2 groups: the thrombomodulin low (TML) group (n=25) and thrombomodulin high (TMH) group (n=25). The concentration of sTM was 4.4 [3.4, 4.7] ng/ml in the TML-group and 8.7[7.3, 10.6] ng/ml in the TMH-group. After surgery, D-dimer, vWF, platelet count and CRP were higher and total blood loss was lower in the TML group. In the TML-group, a symptomatic DVT was detected in 3(12%) patients; in the TMH-group, a symptomatic DVT was identified only in 1(4%) case.
Conclusion: These findings support the important role of sTM in coagulation, inflammation, bleeding, and presumably in venous thrombosis after major orthopedic surgery.

thrombomodulin; coagulation; bleeding; total hip and knee replacement.
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