thromboplastin and Fractures--Bone

This study was undertaken to provide evidence for the mechanism of venous thromboembolism (VTE) in healthy patients with minor lower limb injury (fracture; Achilles tendon rupture) that was medically managed with plaster cast/brace immobilization. The Plaster Cast clinical trial provided a unique opportunity to identify the natural history of VTE using placebo-controlled patients (n = 183) with validation of the mechanism using the low-molecular-weight heparin (LMWH; reviparin)-treated patients (n = 182). Confirmed VTE in this population was associated with a burst of tissue factor release (and a minor fibrinolytic deficit) leading to thrombin generation that was sustained at least 5 weeks, greater with fractures than with soft-tissue injuries and greater with surgery than with conservative treatment. The root cause likely involves platelet/leukocyte activation (inflammation) rather than endothelial cell injury. Thromboprophylaxis with a low dose of LMWH reduced thrombin generation, with patients undergoing surgery benefitting the most.

Topics: Achilles Tendon; Anticoagulants; Double-Blind Method; Female; Fractures, Bone; Heparin, Low-Molecular-Weight; Humans; Lower Extremity; Male; Middle Aged; Prospective Studies; Tendon Injuries; Thromboplastin; Time Factors; Venous Thromboembolism

Tissue factor (TF) is the primary activator of the extrinsic coagulation protease cascade. Although TF plays roles in various pathological states, such as thrombosis, inflammatory diseases, cancer, and atherosclerosis, its involvement in bone metabolism remains unknown.. The present study examined the roles of TF in delayed bone repair induced by a diabetic state in mice using wild-type (WT) and low TF-expressing (LTF) male mice. A diabetic state was induced by intraperitoneal injections of streptozotocin (STZ).. A prolonged diabetic state significantly reduced total and trabecular bone mineral densities (BMD) as well as cortical bone thickness in WT and LTF mice; these BMD parameters were similar between WT and LTF mice treated with or without STZ. The diabetic state induced in WT mice delayed the repair of the femur following injury. The diabetic state induced in LTF mice was associated with further delays in bone repair. In in vitro experiments, TF significantly decreased receptor activator of nuclear factor-κB ligand-induced osteoclast formation and osteoclastogenic gene expression in RAW264.7 cells. However, it did not affect the gene expression levels of runt-related transcription factor 2 and osterix as well as alkaline phosphatase activity in mouse primary osteoblasts.. Low TF state was associated with enhanced bone repair delay induced by diabetic state in mice. The TF-induced suppression of bone remodeling may be a contributing factor to the protective effects of TF against delayed bone repair in a diabetic state.

Topics: Animals; Bone Density; Bone Regeneration; Diabetes Mellitus, Experimental; Fractures, Bone; Male; Mice; Mice, Inbred C57BL; Osteoclasts; Thromboplastin

As US healthcare expenditures continue to rise, there is significant pressure to reduce the cost of inpatient medical services. Studies have estimated that over 70% of routine labs may not yield clinical benefits while adding over $300 in costs per day for every inpatient. Although orthopaedic trauma patients tend to have longer inpatient stays and hip fractures have been associated with significant morbidity, there is a dearth of data examining pre-operative labs in predicting post-operative adverse events in these populations. The purpose of this study was to assess whether pre-operative labs significantly predict post-operative cardiac and septic complications in orthopaedic trauma and hip fracture patients.. Between 2006 and 2013, 56,336 (15.6%) orthopaedic trauma patients were identified and 27,441 patients (7.6%) were diagnosed with hip fractures. Pre-operative labs included sodium, BUN, creatinine, albumin, bilirubin, SGOT, alkaline phosphatase, white count, hematocrit, platelet count, prothrombin time, INR, and partial thromboplastin time. For each of these labs, patients were deemed to have normal or abnormal values. Patients were noted to have developed cardiac or septic complications if they sustained (1) myocardial infarction (MI), (2) cardiac arrest, or (3) septic shock within 30 days after surgery. Separate regressions incorporating over 40 patient characteristics including age, gender, pre-operative comorbidities, and labs were performed for orthopaedic trauma patients in order to determine whether pre-operative labs predicted adverse cardiac or septic outcomes.. 749 (1.3%) orthopaedic trauma patients developed cardiac complications and 311 (0.6%) developed septic shock. Multivariate regression demonstrated that abnormal pre-operative platelet values were significantly predictive of post-operative cardiac arrest (OR: 11.107, p=0.036), and abnormal bilirubin levels were predictive (OR: 8.487, p=0.008) of the development of septic shock in trauma patients. In the hip fracture cohort, abnormal partial thromboplastin time was significantly associated with post-operative myocardial infarction (OR: 15.083, p=0.046), and abnormal bilirubin (OR: 58.674, p=0.002) significantly predicted the onset of septic shock.. This is the first study to demonstrate the utility of pre-operative labs in predicting perioperative cardiac and septic adverse events in orthopaedic trauma and hip fracture patients. Particular attention should be paid to haematologic/coagulation labs (platelets, PTT) and bilirubin values.. Prognostic Level II.

Topics: Aged; Bilirubin; Cost-Benefit Analysis; Diagnostic Tests, Routine; Female; Fractures, Bone; Humans; Male; Multiple Trauma; Myocardial Infarction; Orthopedic Procedures; Orthopedics; Platelet Count; Postoperative Complications; Predictive Value of Tests; Preoperative Period; Prognosis; Shock, Septic; Surgical Wound Infection; Thromboplastin; United States; Unnecessary Procedures

Topics: Adolescent; Adult; Aged; Blood Platelets; Blood Sedimentation; Carbon Dioxide; Embolism, Fat; Female; Fibrinogen; Fractures, Bone; Hematocrit; Hemoglobins; Humans; Hydrogen-Ion Concentration; Male; Middle Aged; Oxygen; Prothrombin Time; Pulmonary Diffusing Capacity; Pulmonary Embolism; Reticulocytes; Thromboplastin; Triglycerides

Topics: Animals; Femoral Vein; Fractures, Bone; Heparin; Injections, Intramuscular; Ligation; Rats; Thromboplastin; Thrombosis

Topics: Adipose Tissue; Adolescent; Adult; Aged; Blood Coagulation; Bone Marrow; Brain Chemistry; Factor VIII; Female; Fracture Fixation; Fractures, Bone; Fractures, Spontaneous; Hematoma; Hemophilia A; Hemophilia B; Hemorrhage; Humans; Male; Middle Aged; Muscles; Plasma; Radiography; Thromboplastin

Topics: Blood Coagulation Disorders; Fractures, Bone; Humans; Thromboplastin

Topics: Animals; Fractures, Bone; Liver; Rats; Thromboplastin; Wound Healing