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Influence of Bone Marrow Fat Embolism on Coagulation Activation in an Ovine Model of Vertebroplasty

Krebs, Jorg, Ferguson, Stephen J., Hoerstrup, Simon P., Goss, Benjamin G., Haeberli, Andre, & Aebli, Nikolaus (2008) Influence of Bone Marrow Fat Embolism on Coagulation Activation in an Ovine Model of Vertebroplasty. Journal of Bone and Joint Surgery: American Volume, 90(2), pp. 349-356.

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Abstract

Background: Intraoperative cardiovascular deterioration as a result of pulmonary embolization of bone marrow fat is a potentially serious complication during vertebroplasty. The release of fatty material and thromboplastin from the bone marrow cavity during vertebroplasty may activate the coagulation cascade resulting in thrombogenesis, and pharmacological prophylaxis may therefore prevent cardiovascular complications. Thus, the effects of bone marrow fat embolism on coagulation activation during vertebroplasty were investigated with use of an animal model. Methods: Polymethylmethacrylate was injected into three lumbar vertebrae of six sheep in order to force bone marrow fat into the circulation. Invasive blood pressures and heart rate were recorded continuously until sixty minutes after the last injection. Cardiac output, arterial and mixed venous blood gas parameters, and coagulation parameters were measured at selected time-points. Postmortem lung biopsy specimens were assessed for the presence of intravascular fat.

Results: Embolization of bone marrow fat resulted in a sudden and dramatic increase in mean pulmonary arterial pressure and a decrease in mean arterial blood pressure. There were no significant changes in any coagulation parameter from before the injection to after the injection. Intravascular fat and bone marrow cells were present in all lung lobes.

Conclusions: Injection of polymethylmethacrylate into vertebral bodies caused embolization of bone marrow fat with subsequent transient cardiovascular deterioration, but no changes in coagulation parameters were observed. Thromboembolism did not contribute to the observed cardiovascular changes.

Clinical Relevance: Cardiovascular complications as a result of bone marrow fat embolism should be considered in patients undergoing vertebroplasty. Vertebroplasty with use of polymethylmethacrylate does not appear to activate the coagulation system or cause thromboembolism.

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13 citations in Web of Science®

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ID Code: 14060
Item Type: Journal Article
Additional Information: Self-archiving of the author-version is not yet supported by this publisher. For more information, please refer to the journal's website (see hypertext link) or contact the author.
DOI: 10.2106/JBJS.G.00058
ISSN: 1535-1386
Subjects: Australian and New Zealand Standard Research Classification > MEDICAL AND HEALTH SCIENCES (110000) > MEDICAL BIOCHEMISTRY AND METABOLOMICS (110100) > Medical Biochemistry and Metabolomics not elsewhere classified (110199)
Divisions: Past > QUT Faculties & Divisions > Faculty of Built Environment and Engineering
Current > Institutes > Institute of Health and Biomedical Innovation
Copyright Owner: Copyright 2008 British Editorial Society of Bone and Joint Surgery
Deposited On: 23 Oct 2008
Last Modified: 29 Feb 2012 23:49

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