Effect of preoperative platelet alpha-granules secretion on hemostasis and blood loss in large joint arthroplasty

Abstract

Background. Currently, it was proven that the role of platelets is not limited to the formation of a clot that stops blood loss and provides vascular wall repair. The importance of determining the functional characteristics of platelets in patients who underwent traumatic surgery is beyond doubt. However, there are few studies on this subject.

Aim. To determine the effect of the preoperative platelet α-granules secretory activity on the coagulation parameters and blood loss in total hip arthroplasty (THA).Material and methods. The study included 58 patients admitted to the hospital for primary total hip arthroplasty. All patients were divided into 2 groups according to the preoperative plasma level of the specific platelet α-granules protein β-thromboglobulin (β-TG). The group with a low plasma level of β-thromboglobulin (<30 IU/ml) consisted of 30 patients, the group with a high level (≥30 IU/ml) — 28 patients. Blood sampling was carried out 1 day before the operation, 30 minutes after surgery, on the 1st, 3rd, 7th 14th days after the total hip arthroplasty. The platelet count, β-thromboglobulin, and D-dimer levels were determined. The plasma coagulation was examined by using thromboelastography. The volume of intraoperative blood loss was estimated by the gravimetric method, postoperative blood loss — by drainage volume. Statistical analysis was carried out by using the Friedman, Wilcoxon, Mann–Whitney tests, calculating Spearman's rank correlation coefficient. All calculations were performed using the Statistica 8.0 software.

Results. Before surgery, the group with a high level of β-thromboglobulin showed significantly higher levels of D-dimer than the group with low levels: 132 [73; 191] ng/ml and 79 [37; 123] ng/ml (p=0.024); and shorter R times (time to onset of clotting): 13.7 [11.5; 15.3] min and 15.5 [13.0; 18.1] min (p=0.048), respectively. The maximum β-thromboglobulin was observed at the end of the operation. The release of β-thromboglobulin was significantly more intense in the group with low levels of β-thromboglobulin than in the group with high levels: 35.6 [10.5; 78.0] IU/ml and 19.0 [0; 41.3] IU/ml, respectively (p=0.027). A relationship was found between β-thromboglobulin levels and D-dimer concentration early after surgery (30 minutes), Spearman's correlation coefficients for groups with low and high levels of β-thromboglobulin: r=0.57 and r=0.48, respectively (p <0.05 for both). Blood loss in the group with low β-thromboglobulin levels was significantly higher than in the group with high levels: 850 [550; 1050] ml and 600 [500; 850] ml, respectively (p <0.05).

Conclusion. In patients requiring total hip arthroplasty, an increase in the activity of platelet α-granules secretion is associated with an increase in the activity of fibrin formation and a shortening of reaction time to onset of clotting; during surgery, the secretory activity of platelets is directly related to the activity of coagulation and affects blood loss volume.

Keywords

platelets / β-thromboglobulin / total hip arthroplasty (large joint replacement)

References

[1] Van der Meijden PEJ, Heemskerk JWM. Platelet bio­logy and functions: new concepts and clinical perspectives. Nat Rev Cardiol. 2019;16(3):166–179. DOI: 10.1038/s41569-018-0110-0.

[2] Dukhinova MS, Ponomarev ED. Role of platelets in neuroinflammatory disorders. A review. Moscow university biological scien­ces bulletin. 2018;73(3):97–103. (In Russ.) DOI: 10.3103/S0096392518030069.

[3] Духинова М.С., Пономарёв Е.Д. Роль тромбоцитов в нейровоспалительных заболеваниях. Обзор. Вестник Московского университета. Серия 16. Биология. 2018;73 (3):125–131. DOI: 10.3103/S0096392518030069.

[4] Manne BK, Xiang SC, Rondina MT. Platelet secretion in inflammatory and infectious diseases. Platelets. 2017;28(2):155–164. DOI: 10.1080/09537104.2016.1240766.

[5] Sun P, Wang Y, Xu D, Gong K. The calcium phosphate modified titanium implant combined with platelet-rich plasma treatment promotes implant stabilization in an osteoporotic model. J Craniofac Surg. 2021;32(2):603–608. DOI: 10.1097/SCS.0000000000006836.

[6] Golebiewska EM, Poole AW. Platelet secretion: From haemostasis to wound healing and beyond. Blood Rev. 2015;29(3):153–162. DOI: 10.1016/j.blre.2014.10.003.

[7] Tikhilov RM, Serebryakov AB, Shubnyakov II, Pliev DG, Shilnikov VA, Denisov AO, Myasoedov AA, Boyarov AA. The influence of various factors on blood loss in patients undergoing total hip replacement. Traumatology and Orthopedics of Russia. 2012;65(3):5–11. (In Russ.) DOI: 10.21823/2311-2905-2012--3-5-11.

[8] Тихилов Р.М., Серебряков А.Б., Шубняков И.И., Плиев Д.Г., Шильников В.А., Денисов А.О., Мясоедов А.А., Бояров А.А. Влияние различных факторов на кровопотерю при эндопротезировании тазобедренного сустава. Травматология и ортопедия России. 2012;65(3):5–11. DOI: 10.21823/2311-2905-2012--3-5-11.

[9] Gould WR, Silveira JR, Tracy PB. Unique in vivo modifications of coagulation factor V produce a physically and functionally distinct platelet-derived cofactor: characterization of purified platelet-derived factor V/Va. J Biol Chem. 2004; 279 (4): 2383–2393. DOI: 10.1074/jbc.M308600200.

[10] Blair P, Flaumenhaft R. Platelet alpha-granules: basic biology and clinical correlates. Blood Rev. 2009;23(4):177–189. doi: 10.1016/j.blre.2009.04.001.

[11] De Pascale MR, Sommese L, Casamassimi A, Napo­li C. Platelet derivatives in regenerative medicine: an update. Transfus Med Rev. 2015;29(1):52–61. DOI: 10.1016/j.tmrv.2014.11.001.

[12] Heijnen H, van der Sluijs P. Platelet secretory behaviour: as diverse as the granules… or not? J Thromb Haemost. 2015;13(12):2141–2151. DOI: 10.1111/jth.13147.

[13] Mazurov AV. Fiziologiya i patologiya trombotsitov. (Physiology and pathology of platelets.) M.: Litterra; 2011. 480 p. (In Russ.)

[14] Мазуров А.В. Физиология и патология тромбоцитов. М.: Литтерра; 2011. 480 c. ISBN: 978-5-4235-0049-8.

[15] Mumford AD, Frelinger III AL, Gachet C, Gresele P, Noris P, Harrison P, Mezzano D. A review of platelet secretion assays for the diagnosis of inherited platelet secretion disorders. Thrombosis and Haemostasis. 2015;114 (1):14–25. DOI: 10.1160/th14-11-0999.

[16] Chen CH, Lo RW, Urban D, Pluthero FG, Kahr WH. Alpha-granule biogenesis: from disease to discovery. Platelets. 2017;28(2):147–154. DOI: 10.1080/09537104.2017.12805999.

[17] Van der Meijden PEJ, Heemskerk JWM. Platelet bio­logy and functions: new concepts and clinical perspectives. Nat Rev Cardiol. 2019;16(3):166–179. DOI: 10.1038/s41569-018-0110-0.

[18] Baaten CCFMJ, Ten CH, van der Meijden PEJ. Platelet populations and priming in hematological disea­ses. Blood Reviews. 2017;31(6):389–399. DOI: 10.1016/j.blre.2017.07.004.

[19] Santana DC, Emara AK, Orr MN, Klika AK, Higuera CA, Krebs VE, Molloy RM, Piuzzi NS. An update on venous thromboembolism rates and prophylaxis in hip and knee arthroplasty in 2020. Medicina. 2020;56(9):416. DOI: 10.3390/medicina56090416.

[20] Liu WB, Li GS, Shen P, Zhang FJ. Comparison between epsilon-aminocaproic acid and tranexa­mic acid for total hip and knee arthroplasty: A meta-analysis. J Orthop Surg. 2020;28(3): 2309499020959158. DOI: 10.1177/2309499020959158.

[21] Alexander DC, Butt WW, Best SM, Donath JD, Monagle PT, Shekerdemian LS. Correlation of thromboelastography with standard tests of anticoagulation in paediatric patients receiving extracorporeal life support. Thromb Res. 2010;125(5):387–392. DOI: 10.1016/j.thromres.2009.07.001.

[22] Jonnalagadda D, Izu LT, Whiteheart SW. Platelet secretion is kinetically heterogeneous in an agonist-responsive manner. Blood. 2012;120(26):5209–5216. DOI: 10.1182/blood-2012-07-445080.

[23] Karolczak K, Watala C. Blood platelets as an important but underrated circulating source of TGFbeta. Int J Mol Sci. 2021;22(9):4492. DOI: 10.3390/ijms22094492.

[24] Savage B, McFadden PR, Hanson SR, Harker LA. The relation of platelet density to platelet age: survival of low- and high-density 111indium-labeled platelets in baboons. Blood. 1986;68(2):386–393. DOI: 10.1182/blood.V68.2.386.386.

[25] Weibrich G, Kleis WK, Hafner G, Hitzler WE. Growth factor levels in platelet-rich plasma and correlations with donor age, sex, and platelet count. J Craniomaxillofac Surg. 2002;30(2):97–102. DOI: 10.1054/jcms.2002.0285.

[26] Everts P, Onishi K, Jayaram P, Lana JF, Mautner K. Platelet-rich plasma: New performance understan­dings and therapeutic considerations in 2020. Int J Mol Sci. 2020;21(20):7794. DOI: 10.3390/ijms21207794.

[27] Antropova IP, Rei­no EV, Yushkov BG. The clotting tests and molecular markers in evaluating of coagulation alterations against the background of anti-thrombotic prevention by dabigatran after large orthopedic operations. Klinicheskaya labo­ratornaya diagnostika. 2017;62(1):25–30. (In Russ.) DOI: 10.18821/0869-2084-2017-62-1-25-30.

[28] Антропова И.П., Рейно Е.В., Юшков Б.Г. Клоттинговые тесты и молекулярные маркёры в оценке коагуляционных изменений на фоне антитромботической профилактики дабигатраном после крупных ортопедических операций. Клиническая лабораторная диагностика. 2017;62(1):25–30. DOI: 10.18821/0869-2084-2017-62-1-25-30.

[29] Johnson ED, Schell JC, Rodgers GM. The D-dimer assay. Am J Hematol. 2019;94(7):833–839. DOI: 10.1002/ajh.25482.

[30] Miron RJ, Zhang Y. Autologous liquid platelet rich fibrin: A novel drug delivery system. Acta Biomater. 2018;75(7):35–51. DOI: 10.1016/j.actbio.2018.05.021.

RIGHTS & PERMISSIONS

Eco-Vector