The Impact of Glucagon-Like Peptide-1 Agonists on Hip and Knee Arthroplasty and Perioperative Considerations.

Glucagon-Like Peptide agonists have traditionally been used for glycemic control in diabetic patients. However, there has been a dramatic rise in their utilization for weight loss management. As such, arthroplasty surgeons will encounter an increasing number of patients on these medications, and therefore it is important to understand the implications of their use in the perioperative period. This review will describe the pharmacological actions of these medications as well as the impact on hip and knee arthroplasty patients, and considerations for perioperative management. Because of the rapid adaption and utilization of these drugs, the science is evolving at a fast pace. More and longer-term studies are needed to truly understand the impact of these medications on total joint arthroplasty utilization and in management of these patients in the perioperative period.

The procoagulant properties of purified fibrinogen concentrate are enhanced by carbon monoxide releasing molecule-2.

INTRODUCTION: Fibrinogen concentrate has been demonstrated to enhance coagulation in vitro and in several clinical settings of coagulopathy. We have recently demonstrated that carbon monoxide releasing molecule-2 (tricarbonyldichlororuthenium (II) dimer; CORM-2) enhances fibrinogen as a substrate for thrombin via an attached heme. The objective of this study was to determine if CORM-2 modified fibrinogen concentrate would enhance coagulation more effectively than CORM-2 naïve fibrinogen concentrate. MATERIALS AND METHODS: In the first series of experiments, fibrinogen concentrate (final concentration 300mg/dl) was exposed to 0, 50 or 100µM CORM-2 for 5min at 37°C prior to being added to citrated, fibrinogen depleted plasma. In another series of experiments, citrated plasma obtained from 12 normal subjects was 50% diluted with crystalloid to which was added fibrinogen concentrate (final concentration 300mg/dl) exposed to 0 or 100µM CORM-2. Coagulation was activated with tissue factor (n=8 per condition). Thrombus growth was monitored with thrombelastography for 15min. RESULTS AND CONCLUSIONS: CORM-2 modification of fibrinogen concentrate significantly enhanced the velocity of clot formation (30-50%) and strength (15-31%) in fibrinogen deficient plasma. Similarly, while diluted plasma-derived thrombi demonstrated a marked decrease in velocity of formation (54%) and strength (61%), fibrinogen concentrate significantly enhanced velocity (217%) and strength (171%); however, CORM-2 modified fibrinogen concentrate significantly increased velocity (303%) and strength (205%) to a greater extent. Additional in vitro investigation and in vivo preclinical assessments of the hemostatic efficacy of CORM-2 modified fibrinogen concentrate are warranted.