Changes in Hæmostatic System After Application of a Tourniquet

Klenerman, L.; Chakrabarti, Ranjan; Mackie, IJ; Brozović, Milica; Stirling, Yvonne

doi:10.1016/s0140-6736(77)92276-0

Cited by 112 publications

(68 citation statements)

References 9 publications

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“…This causes increased hemorrhage into adjacent traumatized tissue in the perioperative period [2,25,47]. Another proposed hypothesis is the increased fibrinolytic activity associated with tourniquet-induced ischemia causes bleeding in adjacent soft tissues postoperatively [25,37]. Our results with this relatively small sample size do not support substantial additional hemorrhaging either with or without tourniquet use in that total blood loss and postoperative edema were not different between those patients whose procedures were performed under tourniquet control and those whose were not.…”

Section: Discussionmentioning

confidence: 53%

“…It is theorized that tourniquet-induced ischemia results in sustained local reactive hyperemia lasting many hours after tourniquet deflation. This causes increased hemorrhage into adjacent traumatized tissue in the perioperative period [2,25,47]. Another proposed hypothesis is the increased fibrinolytic activity associated with tourniquet-induced ischemia causes bleeding in adjacent soft tissues postoperatively [25,37].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Dennis

Kittelson

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

170

148

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Background Tourniquet use during total knee arthroplasty (TKA) improves visibility and reduces intraoperative blood loss. However, tourniquet use may also have a negative impact on early recovery of muscle strength and lower extremity function after TKA. Questions/purposes The purpose of this study was (1) to determine whether tourniquet use affects recovery of quadriceps strength (primary outcome) during the first 3 postoperative months; and (2) to examine the effects of tourniquet application on secondary outcomes: voluntary quadriceps activation, hamstring strength, unilateral limb balance as well as the effect on operative time and blood loss.Methods Twenty-eight patients (mean age 62 ± 6 years; 16 men) undergoing same-day bilateral TKA (56 lower extremities) were enrolled in a prospective, randomized study. Subjects were randomized to receive a tourniquetassisted knee arthroplasty on one lower extremity while the contralateral limb underwent knee arthroplasty without extended tourniquet use. In the former group, the tourniquet was inflated just before the incision was made and released after cementation; in the latter group, a tourniquet was not used (10 of 28 [36%]) or inflated only during component cementation (18 of 28 [64%]). The choice of no tourniquet or use just during cementation was based on surgeon choice, because some surgeons felt a tourniquet during cementation was necessary to achieve a dry surgical field to maximize cement fixation. A median parapatellar approach and the One or more of the authors (DAD, CCY, TMM, RHK) has received funding from Porter Adventist Hospital, during the study period, in the amount of USD 10,000 to USD 100,000. One of the authors (DAD) has or may receive payments or benefits from DePuy (Warsaw, IN, USA) in the amount of USD more than USD 1,000,001 not related to this work. One of the authors certifies that he (RHK) has or may receive payments or benefits from Stryker (Kalamazoo, MI, USA) and Innomed (Savannah, GA, USA) in the amount of USD 100,001 to USD 1,000,001 not related to this work. One of the authors (TMM) has or may receive payments or benefits from Zimmer (Warsaw, IN, USA) in the amount of less than USD 10,000 not related to this work. All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research 1 editors and board members are on file with the publication and can be viewed on request. Clinical Orthopaedics and Related Research 1 neither advocates nor endorses the use of any treatment, drug, or device. Readers are encouraged to always seek additional information, including FDAapproval status, of any drug or device prior to clinical use. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.The surgeries for this study were performed at Porter Adventist Hospital, Denver, CO, USA, and the postoperative patient te...

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

Does Tourniquet Use in TKA Affect Recovery of Lower Extremity Strength and Function? A Randomized Trial

Dennis

Kittelson

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

170

148

View full text Add to dashboard Cite

show abstract

“…Estimated blood loss reported for TKA varies between 800 mL to 1800 mL [2,7,13,20,27], mostly related to surgical trauma. Trauma also induces fibrinolysis [2,3,16,26], which in TKA is enhanced by the use of a pneumatic tourniquet [11,17,24,26]. This further contributes to bleeding during and after surgery [5].…”

Section: Introductionmentioning

confidence: 99%

Most Effective Regimen of Tranexamic Acid in Knee Arthroplasty: A Prospective Randomized Controlled Study in 240 Patients

Maniar

Kumar²,

Singhi

et al. 2012

Clinical Orthopaedics &Amp; Related Research

277

256

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Background The antifibrinolytic tranexamic acid reduces surgical blood loss, but studies have not identified an optimal regimen. Questions/purposes We studied different dosages, timings, and modes of administration to identify the most effective regimen of tranexamic acid in achieving maximum reduction of blood loss in TKA. Methods We prospectively studied five regimens (four intravenous, one local; 40 patients each) with a control group (no tranexamic acid). The four intravenous (10-mg/kg dose) regimens included (1) intraoperative dose (IO) given before tourniquet deflation, (2) additional preoperative dose (POIO), (3) additional postoperative dose (IOPO), and (4) all three doses (POIOPO). The fifth regimen was a single local application (LA). Two independent parameters of drain loss and total blood loss, calculated by the hemoglobin balance method, were evaluated statistically. Results Both parameters were reduced in all five regimens as against the control. A significant reduction in drain loss was seen in the POIO, IOPO, and POIOPO groups whereas total blood loss was significantly reduced in the POIO, POIOPO, and LA groups. The POIOPO group had the least drain loss (303 mL) and least total blood loss (688 mL). The IO group had the greatest drain loss and the IOPO group the greatest total blood loss. Conclusions Single-dose tranexamic acid did not give effective results. The two-dose regimen of POIO was the least amount necessary for effective results. When compared against the control, this regimen produced reduction of drain loss and total blood loss, whereas the IOPO regimen did not. The three-dose regimen of POIOPO produced maximum effective reduction of drain loss and total blood loss.

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“…The soft tissues in and around the hip, notably the significant adipose tissue in the subdermal layers of the thigh, makes the patient undergoing hip replacement vulnerable to a significant amount of unrecognized blood loss during and after the operative procedure. In Total Knee Arthroplasty a tourniquet can be applied prior to the operation given the distal nature of the skin incision but the use of tourniquet leads to hyperfibrinolysis which in itself increases bleeding (2). Despite immense improvements in surgical as well as anesthetic techniques major orthopedic surgeries like joint replacement surgeries are commonly associated with marked blood loss, and a subsequent need for blood transfusion is often encountered.…”

Section: Introductionmentioning

confidence: 99%