Haemostatic disorders in orthopedic surgery: Laboratory diagnosis

Coagulative disorders may result from a breakdown in the balance between coagulation and fibrinolysis. It is important to assess relative physiological states of coagulation and fibrinolysis related to operation. An ideal outcome in orthopaedic surgical procedures is the achievement of adequate haemostasis without excessive bleeding despite transection of numerous blood vessels, a necessary part of any surgical procedure. Meticulous attention to secure intraoperative haemostasis is a surgeon's responsibility. The postoperative haemostatic response to injury must also lead to a hypercoagulable state and thrombosis because it is also accompanied by stasis and vessel injury, fulfilling Virchow's triad. For discussion of prophylaxis and treatment of venous thromboembolic disease and orthopaedic surgical bleeding, the reader is referred to other articles. This paper discusses selected conditions leading to postoperative bleeding and thrombosis after orthopaedic surgery as well as laboratory diagnosis.