Using laboratory tests of hemostasis for prediction of interoperative bleeding after surgical treatment of tumors of the musculoskeletal system



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Abstract

BACKGROUND: Surgical resection of musculoskeletal tumors is frequently associated with significant blood loss; however, data on effective strategies to assess and mitigate intraoperative bleeding remain limited. To date, no systematic investigation has been conducted to identify predictors of blood loss among hemostatic laboratory parameters in these patients.

AIM: This study aimed to identify hemostasis laboratory tests correlating with the intraoperative blood loss volume and to discriminate the proper markers based on the ROC-analysis.

METHODS: A total of 120 patients (58 males, 62 females; aged 18–89 years) undergoing musculoskeletal tumor surgery with high blood loss (≥1000 ml) or low blood loss (≤200 ml) were included. Blood samples were collected before surgery. Clotting times, fibrinogen and D-dimer levels, and global assay thrombodynamics were analyzed.

RESULTS: Preoperative hemostasis state of patients was characterized by elevated fibrinogen and D-dimer concentrations, and increased clotting activity in thrombodynamics, while parameters of activated partial thromboplastin time, prothrombin time according to Quick and thrombin time were prolonged or normal. Predictors of high intraoperative blood loss included: Prothrombin activity <94.9% (ROC-AUC = 0.730), fibrinogen >3.69 g/L (0.647), D-dimer >0.8 mg/L (0.714), Tlag >1.65 min (0.611), Vi <53.85 µm/min (0.672), V <39.25 µm/min (0.679), D >27.53×10³ a.u. (0.743), and absence of spontaneous clots in thrombodynamics preoperatively.

CONCLUSION: Preoperative values of Prothrombin, fibrinogen, D-dimer, and global assay thrombodynamics can be used as markers of high blood loss during surgical resection of musculoskeletal tumors.

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About the authors

Anna Balandina

Центр теоретических проблем физико-химической фармакологии РАН

Author for correspondence.
Email: a_balandina@inbox.ru
ORCID iD: 0000-0002-7032-695X
Russian Federation

Nadezhda Podoplelova

Email: podoplelovan@yandex.ru

Anna Chankina

Email: chankinaAA@zdrav.mos.ru

Sergey Zuzov

Email: zuzov@mail.ru

Elmar Musaev

Email: mer71@mail.ru

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