Rublenko A. Risk assessments and prevention of venous thromboembolic and hemorrhagic complications in hip replacement.

Object: venous thromboembolic and hemorrhagic complications after total hip replacement. Objective: to establish criteria for risk and improve methods of prevention for venous thromboembolic and hemorrhagic complications of hip replacement to improve its results. Methods: The clinical, radiographic, ultrasonographic, hemostasiologic, statistics. For the first time found that the vast majority of patients with hip arthroplasty simultaneously determined by two or more risk factors for venous thromboembolic events and hypercoagulative state of the homeostasis system, which are more pronounced in patients with fractures of the femoral neck. Established that postoperative hypercoagulative condition worsens, particularly in patients with femoral neck fractures achieving hemostasis for multiple features maximum on the seventh day, and kept after discharge of patients from hospital. It was proved that in the blood of the patients after hip arthroplasty the increase level of soluble fibrin monomer complexes twice or more times without a simultaneous significant increase in the concentration of D-dimer is accompanied by an increase in the frequency of venous thrombosis of lower extremities in 5 times. It was established that the use after hip replacement low molecular weight heparins accompanied by quite a significant rate of bleeding complications, which is more than twice higher among patients with fractures of the femoral neck. It was proposed the algorithm that estimated the risk of venous thromboembolic complications and choice of duration of low molecular weight heparins thromboprophylaxis. The application in the case of hip replacement tranexamic acid can reduce the need for blood transfusions and the incidence of bleeding complications. The results introduced in the clinical practice of the traumatology department of the Vinnytsia urgent city hospital of the Vinnytsia city Council, traumatology department of the Vinnytsia regional clinical hospital of the Vinnytsia regional council, the orthopedic department of the Research Institute for Rehabilitation of the Disabled of the Vinnitsa National Medical Pirogov Memorial University and surgical department of the Vinnitsa Central District Hospital of the Vinnytsia district council. Traumatology and orthopedics.