Plasma D-dimer and FDP are promising biomarkers to predict perioperative fibrinolysis and bleeding following primary total joint arthroplasty

Abstract

Perioperative bleeding is associated with postoperative hyperfibrinolysis caused by surgical trauma in the setting of total hip and knee arthroplasty (THA/ TKA). The study aimed to clarify the dynamics of postoperative fibrinolytic activity and the values of fibrin degeneration products and thromboelastography (TEG) to guide precisive antifibrinolytic therapy. Forty three patients undergoing primary unilateral THAs and 40 TKAs were included to the prospective observational cohort study. Venous blood sample at different time points (preoperative, intraoperative, postoperative 6 hours, 12 hours, 24 hours, 48 hours) were drawn to test D-dimer, fibrin (-ogen) degradation products (FDP) and TEG. The TEG parameters associated with coagulation (R, K, α, MA, and CI) and fibrinolysis (estimate percent lysis and Ly30) were all in normal range although had a higher level than preoperative time ( P < .05). The postoperative levels of D-dimer and FDP were higher than preoperative level ( P < .05). The dynamics of D-dimer and FDP presented a bimodal pattern, which peaked at 6 hours postoperatively, then remained and decreased until 24 hours, but would rebound at 48 hours postoperatively with smaller amplitude. Moreover, FDP 6h ( P = .028), D-Dimer 6h ( P = .044), FDP 12h ( P = .009), D-dimer 12h ( P = .007), and FDP 48h ( P = .016) were all correlated with total blood loss on POD3. FDP and D-dimer were effective and practical markers for prediction of acute postoperative fibrinolytic activity, which peaked at 6 hours after end of surgery and would maintain for at least 24 hours.

Fibrinolysis as a Causative Mechanism for Bleeding Complications on Extracorporeal Membrane Oxygenation: A Pilot Observational Prospective Study

“…D-dimers are thus an effective and practical routine marker for early prediction of acute fibrinolytic activity and occurrence of a hemorrhagic complication. 33 In this context, we propose that the increased D-dimer levels originate during ongoing fibrinolysis from fibrin deposits in vascular and tissue lesions, 30 which aligns with the higher tPA concentration. The concentration of plasmin–antiplasmin complexes, which are passive markers of plasmin formation, was also increased.…”

“…7,27,28 Elevated D-dimer levels often suggest ongoing fibrinolysis. 29,30 Balaguer et al 8 demonstrated in cardiopulmonary bypass patients that blocking bradykinin B2 receptor led to a reduction in fibrinolytic capacity comparable to ε-aminocaproic acid. However, D-dimer formation was specifically decreased only by the latter, likely attributed to its direct impact on plasminogen fibrin-binding function.…”

Care willingness and demand of residents under 60 years of age in western China: a cross-sectional study

“…The Strengthening the Reporting of Observational studies in Epidemiology (STROBE) cross-sectional reporting guidelines were used. 17…”

Relationship between plasma fibrinogen degradation products(FDP) and D-dimer levels and disease activity in rheumatoid arthritis: A STROBE compliant article

“…Currently, there is a lack of other convenient and effective serological indicators for assessing RA activity. [1] Fibrinogen degradation products (FDP) and D -dimer are products of the activated fibrinolytic system that are closely associated with thrombotic diseases, and high FDP and D -dimer levels are also observed in patients with malignant diseases, [2,3] pregnancy, [4] prosthetic replacement arthroplasty, [5] novel coronavirus pneumonia, [6] and sepsis. [7] Cerebral and myocardial infarctions are common thrombotic disorders associated with atherosclerosis.…”