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International Orthopaedics

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01-11-2022 | Original Paper

Does living at high altitude increase the risk of bleeding events after total knee arthroplasty? A retrospective cohort study

Authors: Cheng-cheng Zhao, Li-yile Chen, Chang-jun Chen, Qiu-ru Wang, Qian-hao Li, Peng-de Kang

Published in: International Orthopaedics | Issue 1/2023

Abstract

Objective

Post-operative bleeding after total knee arthroplasty (TKA) is a frequent cause of post-operative complications. This study compared blood loss and indicators of coagulation and fibrinolysis between TKA patients living at low or high altitudes.

Methods

We retrospectively analyzed 120 patients at our institution who underwent primary TKA from May 2019 to March 2020, and we divided them into those living in areas about 500 m or > 3000 m above sea level. We compared the primary outcome of total blood loss between them. We also compared them in terms of several secondary outcomes: coagulation and fibrinolysis parameters, platelet count, reduction in hemoglobin, hidden blood loss, intra-operative blood loss, transfusion rate, and incidence of thromboembolic events and other complications.

Results

Total blood loss was significantly higher in the high-altitude group than in the low-altitude group (mean, 748.2 mL [95% CI, 658.5–837.9] vs 556.6 mL [95% CI, 496.0–617.1]; p = 0.001). The high-altitude group also showed significantly longer activated partial thromboplastin time, prothrombin time, and thrombin time before surgery and on post-operative day one, as well as increased levels of fibrinogen/fibrin degradation product on post-operative days one and three. Ecchymosis was significantly more frequent in the high-altitude group (41.7 vs 21.7%; relative risk (RR) = 1.923 [95% CI, 1.091–3.389]; p = 0.019). The two groups showed similar transfusion rates, and none of the patients experienced venous thromboembolism, pulmonary embolism, or infection.

Conclusion

High altitude may alter coagulation and fibrinolysis parameters in a way that increases risk of blood loss after TKA. Such patients may benefit from special management to avoid bleeding events.

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Title: Does living at high altitude increase the risk of bleeding events after total knee arthroplasty? A retrospective cohort study
Authors: Cheng-cheng Zhao
Li-yile Chen
Chang-jun Chen
Qiu-ru Wang
Qian-hao Li
Peng-de Kang
Publication date: 01-11-2022
Publisher: Springer Berlin Heidelberg
Published in: International Orthopaedics / Issue 1/2023
Print ISSN: 0341-2695
Electronic ISSN: 1432-5195
DOI: https://doi.org/10.1007/s00264-022-05614-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Does living at high altitude increase the risk of bleeding events after total knee arthroplasty? A retrospective cohort study

Abstract

Objective

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Methods

Results

Conclusion

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