# Dynamics of Haemostatic and Inflammatory Biomarkers in Patients with Combat-Related Injuries to Major Joints Before and After Surgical Treatment

## TL;DR

This study tracks blood markers related to clotting and inflammation in combat-injured patients before and after surgery, finding significant changes that could help assess and manage their risk of blood clot complications.

## Contribution

The study identifies specific preoperative and postoperative thromboinflammatory biomarkers that could improve risk assessment and monitoring in combat-related joint trauma patients.

## Key findings

- Preoperative levels of CRP, fibrinogen, D-dimer, and soluble fibrin complexes were significantly elevated in combat-injured patients.
- Postoperative data showed intensified thromboinflammatory responses, with strong correlations between inflammatory and coagulation markers.
- Antithrombin III activity was reduced preoperatively, and fibrinolysis time was prolonged, indicating impaired clot regulation.

## Abstract

Background/Objectives: Combat trauma involving large joints is associated with a high risk of thromboinflammatory complications. Early identification of laboratory markers for hypercoagulability is essential to optimise perioperative management. This study aimed to evaluate the dynamics of inflammation and haemostasis indicators in patients with combat-related joint trauma and to identify the most informative markers for preoperative risk assessment. Methods: A total of 29 patients with combat injuries to the hip, knee, elbow, or ankle joints were examined. Blood samples were taken 1–3 days prior to surgery and again on the first postoperative day. Parameters of coagulation (e.g., PT, INR, fibrinogen, D-dimer, soluble fibrin complexes, antithrombin III), fibrinolysis, and inflammation (e.g., CRP, haptoglobin, sialic acid, ESR, LSI, LII) were analysed and compared to those of 30 healthy controls. Statistical analysis included Student’s t-test and Pearson’s correlation. Results: At baseline, patients demonstrated significant increases in inflammatory markers (CRP 64.2 ± 7.3 mg/L, ↑738.9%; haptoglobin 3.25 ± 0.4 g/L, ↑164.3%; ESR 46.8 ± 5.2 mm/h, ↑313.8%) and procoagulant activity (D-dimer 1.42 ± 0.18 µg/mL, ↑136.6%; fibrinogen 6.12 ± 0.51 g/L, ↑102.4%; soluble fibrin complexes 38.7 ± 4.9 mg/L, ↑597.3%), together with a reduction in antithrombin III activity (63.5 ± 6.2%, ↓39.5%) and prolonged fibrinolysis time (increase by 197%). Postoperatively, these abnormalities intensified, indicating a sustained thromboinflammatory response. Strong correlations were found between inflammatory and haemostatic markers. Conclusions: Combat trauma of large joints is associated with preoperative thromboinflammatory dysregulation, which is exacerbated by surgery. Monitoring specific biochemical and haematological markers—such as CRP, fibrinogen, D-dimer, and soluble fibrin complexes—may support preoperative risk assessment and postoperative monitoring strategies for hypercoagulable states in this high-risk group. These findings lay the groundwork for future prospective studies aimed at developing stratified therapeutic protocols and predictive models for thromboinflammatory complications in orthopaedic trauma care.