Assuntos
Anticoagulantes/administração & dosagem , Protocolos Clínicos , Assistência Perioperatória/métodos , Complicações Pós-Operatórias/prevenção & controle , Administração Oral , Procedimentos Cirúrgicos Ambulatórios , Anticoagulantes/uso terapêutico , Contraindicações de Medicamentos , Substituição de Medicamentos , Procedimentos Cirúrgicos Eletivos , Heparina de Baixo Peso Molecular/administração & dosagem , Humanos , Comunicação Interdisciplinar , Assistência Perioperatória/educação , Recursos Humanos em Hospital/educação , Hemorragia Pós-Operatória/induzido quimicamente , Hemorragia Pós-Operatória/prevenção & controle , Tromboembolia/prevenção & controle , Comunicação por Videoconferência , Vitamina K/administração & dosagemRESUMO
BACKGROUND AND OBJECTIVE: Surgery promotes a state of hypercoagulability, predisposing to the possibility of postoperative thromboembolic complications. Our aim was to determine whether certain combinations of techniques (neuraxial, intravenous or both) for anesthesia and analgesia might be associated with attenuation of the prethrombotic state following total hip or knee replacement. METHODS: Prospective longitudinal study of 45 patients undergoing elective hip or knee prosthetic surgery. The patients were randomized to 3 groups to receive different anesthesia-analgesia combinations: spinal-intravenous, spinal-epidural, or general-intravenous. From induction until 36 hours after surgery, we recorded the postoperative time course of the following markers of coagulation and fibrinolysis: platelet count; fibrinogen level; activated partial thromboplastin time; international normalized ratio; and levels of prothrombin activation fragments 1 and 2, thrombin-antithrombin III complex, and D-dimer. RESULTS: No statistically significant between-group differences were found in patient demographic, clinical, surgical or postoperative data. No symptomatic thromboembolic complications or deaths were recorded in the 30 days after surgery. Statistically significant differences were found in laboratory results for samples taken 36 hours after surgery. Patients who received spinal-epidural anesthesia and analgesia had lower levels of prothrombin activation fragments 1 and 2 and longer activated partial thromboplastin times than the group receiving the spinal-intravenous combination. CONCLUSIONS: The anesthetic technique used during surgery did not affect hemostasis. However, continuous epidural analgesia in the postoperative recovery period attenuated some markers of hypercoagulability.
