• Unlike knee arthroscopy, lower-leg injury is associated with increased plasma levels of factor VIII, von Willebrand Factor, and D-dimer

  • In both situations, coagulation is affected differently, which suggests that there are different pathways towards venous thromboembolism.

Lower-leg injury and knee arthroscopy are associated with increased venous thromboembolism (VTE) risk. It is unknown how these conditions affect coagulation. To study the effect of 1) lower-leg trauma and 2) knee arthroscopy on coagulation. Plasma samples of the POT-(K)CAST trials were used, which were collected shortly after lower-leg trauma (POT-CAST, clinicaltrials.gov identifier NCT01542762) and before/after (<4 hours) knee arthroscopy (POT-KAST, clinicaltrials.gov identifier NCT01542723). For aim 1, 1204 lower-leg injury patients were compared with preoperative samples of 1001 controls. Mean differences/ratios (if ln-retransformed due to skewedness) were adjusted for sex, age, body mass index, comorbidity, malignancy, oral contraceptives using linear regression. For aim 2, pre- and postoperative samples of 715 arthroscopy patients were compared resulting in paired mean changes. Plasma levels of fibrinogen, factor (F)VIII, IX, XI, von Willebrand Factor (VWF), D-dimer were measured in all individuals. Parameters of underlying mechanisms (including tissue factor, interleukin-6 [IL-6], myeloperoxidase-DNA, cell-free DNA) were measured in random subsets. In patients with lower-leg injury, plasma levels of coagulation parameters increased, especially FVIII, VWF and D-dimer, i.e., adjusted mean differences: FVIII 26.8% (95%CI 23.7;29.9), FIX 13.8% (95%CI 11.9;15.6), FXI 5.1% (95%CI 3.3;7.0), VWF 29.8% (95%CI 26.0;33.6), fibrinogen 32.5 mg/dL (95%CI 25.8;39.2), D-dimer [mean ratio] 3.3 (95%CI 3.1;3.6). Levels of remaining parameters were unchanged, except for (somewhat) increased IL-6 levels. After knee arthroscopy, plasma levels of all parameters decreased. Lower-leg trauma is associated with increased procoagulant factor levels, in contrast to knee arthroscopy. This finding suggests that in both situations, different pathways are involved in development of VTE.

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