Changes in coagulation‐fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism

Katsumata, Seishi; Nagashima, Masakazu; Katô, Kôji; Tachihara, Akitoshi; Wauke, K.; Saito, Seiji; Jin, Eun Hyo; Kawanami, Oichi; Ogawa, Ryo; Yoshino, Shinichi

doi:10.1111/j.1399-6576.2005.00621.x

Cited by 62 publications

(48 citation statements)

References 31 publications

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“…31 In addition, intra-articular tranexamic acid injection has the advantage of inducing partial microvascular hemostasis by stopping fibrin clot dissolution in the affected area. 32 Although the current authors were able to show a significant improvement in the postoperative hemoglobin decrease, they were unable to show an improvement in the rate or number of units needed to transfuse. Because no clear parameters were defined in either group for the indications for transfusion, it was likely susceptible to bias.…”

Section: Discussioncontrasting

confidence: 58%

Effect of Intra-articular Injection of Tranexamic Acid on Postoperative Hemoglobin in Total Hip Arthroplasty

Bagsby¹,

Hur²

2014

Orthopedics

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Postoperative anemia is a significant risk factor in total hip arthroplasty, leading to increased length of hospital stay and delayed mobility and rehabilitation, and is poorly tolerated by patients with peripheral vascular and cardiovascular disease. Intravenous tranexamic acid, an antifibrinolytic drug, has been shown to reduce postoperative anemia in total joint replacement. Intra-articular administration eliminates the risk of systemic effects, the most concerning of which is thrombosis. Although this method of administering tranexamic acid has been studied in total knee replacement, currently no literature has been published on its efficacy in primary total hip replacement. The purpose of this study was to examine postoperative hemoglobin decrease and the transfusion rate following intra-articular tranexamic acid administration in primary total hip arthroplasty. The authors conducted a retrospective review of 181 consecutive total hip replacements, 91 of which received tranexamic acid. No statistical significance was found between these groups in any of the demographic variables. Postoperative hemoglobin decrease in the control group was 4.4±1.0 g/dL compared with a decrease of 3.6±1.1 g/dL in the tranexamic group, demonstrating an 18% reduction in blood loss (P<.001). No significant difference was found between the number of patients transfused (P=.777) or the number of units used (P=.993). No clotting events were seen in either group. Overall, the study demonstrates that intra-articular tranexamic acid in primary total hip arthroplasty is associated with a significant improvement in postoperative hemoglobin decrease without systemic hypercoagulability.

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Section: Discussioncontrasting

confidence: 58%

Effect of Intra-articular Injection of Tranexamic Acid on Postoperative Hemoglobin in Total Hip Arthroplasty

Bagsby¹,

Hur²

2014

Orthopedics

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“…Previously we demonstrated that during TKA, the use of a tourniquet increased the NE level 8-fold and suggested that this event may promote the risk of developing PTE, particularly in RA patients [21,37] . On the other hand, the absence of PTE has been associated with a general status of decline in hypercoagulability [26,37] . We attributed this to the so-called 'reperfusion injury', that is to say the release of NE by deflating tourniquet was the most important factor [25,38] .…”

Section: Discussionmentioning

confidence: 89%

Induction of Pulmonary Thromboembolism by Neutrophil Elastase in Collagen-Induced Arthritis Mice and Effect of Recombinant Human Soluble Thrombomodulin

Matsuoka

Jin²,

Tachihara³

et al. 2008

Pathobiology

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We previously reported that during total knee arthroplasty in rheumatoid arthritis (RA) patients, the use of tourniquet might promote local release of neutrophil elastase (NE) from neutrophils, which may contribute to the development of pulmonary thromboembolism (PTE) and tissue injury. The aim of this study was to develop PTE by the use of NE in a mouse model of collagen-induced arthritis (CIA) and investigate the relationship between thrombus and endothelial cells as well as the effect of recombinant human soluble thrombomodulin (rhs-TM) in reducing the risk of PTE. Male DBA/1J mice were injected intracutaneously at several sites with an emulsion containing bovine collagen and later a booster shot to produce CIA mice. Subsequently, NE was injected intravenously 2 times a day for 3 days and after a further 4 days, mice were sacrificed. A group of mice received rhs-TM injections prior to NE injections. We divided the mice into four groups of normal, CIA control, CIA + NE, and CIA + rhs-TM + NE mice and evaluated thrombus formation status. All CIA + NE mice developed PTE. In contrast, no thrombosis was found in normal control, CIA control and CIA + rhs-TM + NE mice. Plasma thrombin level, fibrinogen expression and neutrophil count were increased in CIA + NE mice. Double staining for anticoagulant TM and procoagulant von Willebrand factor (vWF) in pulmonary endothelial cells in normal mice showed a TM-dominant expression while in both CIA control and CIA + NE mice a vWF-dominant expression compatible with coagulant status was observed. Injection of rhs-TM into CIA + NE mice resulted in a phenotypic conversion of endothelial cells from vWF-dominant to TM-dominant expression and a reduction in fibrinogen deposition. These findings demonstrate that by repeated use of NE in CIA mice, it is feasible to produce PTE and to study its pathogenesis and that rhs-TM reduces the risk of PTE. We suggest that in surgical operations of upper and lower extremities in RA patients, the use of a tourniquet should be avoided as it may trigger NE release.

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“…In one study the levels of blood coagulation-fibrinolysis markers, TAT and D-dimer, in the group with a tourniquet were significantly higher compared with the levels in the group without a tourniquet [24]. And increases in fibrinolytic activity in the systemic circulation following the release of occlusive limb tourniquet have been described by other authors [25][26][27].…”

Section: Discussionmentioning

confidence: 83%

Time course of thrombosis and fibrinolysis in total knee arthroplasty with tourniquet application. Local versus systemic activations

Reikerås

Clementsen

2008

J Thromb Thrombolysis

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Changes in coagulation‐fibrinolysis marker and neutrophil elastase following the use of tourniquet during total knee arthroplasty and the influence of neutrophil elastase on thromboembolism

Abstract: We suggest that during TKA, the use of tourniquet induces local release of a large amount of NE from neutrophils, inducing the development of DVT and/or PTE and their exacerbation.

Cited by 62 publications

References 31 publications

Effect of Intra-articular Injection of Tranexamic Acid on Postoperative Hemoglobin in Total Hip Arthroplasty

Effect of Intra-articular Injection of Tranexamic Acid on Postoperative Hemoglobin in Total Hip Arthroplasty

Induction of Pulmonary Thromboembolism by Neutrophil Elastase in Collagen-Induced Arthritis Mice and Effect of Recombinant Human Soluble Thrombomodulin

Time course of thrombosis and fibrinolysis in total knee arthroplasty with tourniquet application. Local versus systemic activations

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