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The role of platelet hyperreactivity in venous thromboembolism after total knee arthroplasty in elderly population without pharmacologic prophylaxis: A single‐center study
Author(s) -
Kim Youngmo,
Park Youngcheol,
Joo Yongbum,
Kim Seon Young,
Kim Jimyung
Publication year - 2019
Publication title -
international journal of laboratory hematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.705
H-Index - 55
eISSN - 1751-553X
pISSN - 1751-5521
DOI - 10.1111/ijlh.12932
Subject(s) - epinephrine , medicine , platelet aggregation , platelet , total knee arthroplasty , mean platelet volume , incidence (geometry) , population , anesthesia , cardiology , surgery , physics , environmental health , optics
While it is suggested that platelet hyperreactivity plays a role in the arterial thrombi, its link with venous thromboembolism ( VTE ) is not well defined. Aggregometry using low concentrations of agonists is proposed as a reliable method to detect hyperreactivity. The aim of this study was to examine whether platelet hyperreactivity affects the development of VTE after total knee arthroplasty ( TKA ). Methods Total 150 elderly patients without VTE history were enrolled. Mechanical prophylaxis was used for VTE after TKA . We performed platelet aggregation using Chrono‐log (Chrono‐log Corporation, USA ) in the presence of low concentrations of ADP (1.0 μmol/L) and epinephrine (0.4, 1.0 μmol/L), and measured maximal aggregation (%). Results At 0.4 μmol/L epinephrine, 69.3%, 15.3%, and 15.3% displayed low (<40%), moderate (40‐60%), and high (>60%) levels of aggregation, respectively. The proportion of high level of aggregation was 36.7%, 30.7% at 1.0 μmol/L of epinephrine and ADP , respectively. The incidence of VTE was higher in the moderate/high aggregation group (10/46, 21.7%) than in the low aggregation group (1/104, 1.0%) at 0.4 μmol/L epinephrine ( P < 0.0001). In predicting postoperative VTE , sensitivity and specificity of ≥40% aggregation at 0.4 μmol/L epinephrine were 90.9% and 74.1%. Higher mean platelet volume and lower volume of blood loss were seen in the high aggregation group than in the low aggregation group. Conclusion Aggregation response to 0.4 μmol/L epinephrine is an optimal assay to classify platelet activity. Platelet hyperreactivity may increase the risk of postoperative VTE in an elderly population, and can be an indication of pharmacologic prophylaxis.