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Muñoz-Mahamud E, Tornero E, Estrada J, Fernández-Valencia J, Martínez-Pastor J, Soriano Á. Usefulness of serum D-dimer and platelet count to mean platelet volume ratio to rule out chronic periprosthetic joint infection. J Bone Jt Infect 2022; 7:109-115. [PMID: 35620591 PMCID: PMC9128364 DOI: 10.5194/jbji-7-109-2022] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background: Diagnosing periprosthetic joint infection (PJI) is challenging and usually requires the evaluation of several biomarkers. Our main aim was to evaluate the usefulness of D-dimer levels as well as the platelet count (PC) to mean platelet volume (MPV) ratio serum as biomarkers to rule out chronic knee and hip infection. Methods: The study enrolled a prospective cohort of 93 patients undergoing hip or knee revision. D-dimer values, PC to MPV ratio, C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were preoperatively determined and evaluated as a predictor of PJI. The definitive diagnosis of PJI was established according to the 2018 International Consensus Meeting criteria. Results: A total of 24 (25.8 %) cases were postoperatively diagnosed with PJI. The median D-dimer value was significantly higher ( p < 0.001) for patients with PJI (1950 ng mL- 1 ) than for patients with aseptic failure (700 ng mL- 1 ). The area under the receiver operating characteristic curves for D-dimer, CRP and ESR was 0.820, 0.793 and 0.791 respectively. D-dimer ≥ 950 ng mL- 1 (91 % sensitivity, 64 % specificity), CRP ≥ 1.95 mg dL- 1 (61 % sensitivity, 90 % specificity) and ESR > 20 (74 % sensitivity, 82 % specificity) were identified as the values with the best balance between sensitivity and specificity. The mean PC to MPV ratio was 37.0 for PJI patients and 29.8 for patients in the aseptic revision cohort ( p = 0 .067). Conclusions: Serum D-dimer levels appear very unlikely to remain normal in the presence of chronic PJI. The 91 % sensitivity when considering 950 ng mL- 1 as the threshold highlights D-dimer as the most accurate initial test to rule out chronic PJI. Conversely, the PC to MPV ratio may be of limited value for accurately diagnosing PJI.
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Affiliation(s)
- Ernesto Muñoz-Mahamud
- Department of Orthopedics and Trauma Surgery, Hospital Clinic of
Barcelona, University of Barcelona, Barcelona, Spain
| | - Eduard Tornero
- Department of Orthopedics and Trauma Surgery, Hospital Clinic of
Barcelona, University of Barcelona, Barcelona, Spain
| | - José A. Estrada
- Department of Orthopedics and Trauma Surgery, Hospital Clinic of
Barcelona, University of Barcelona, Barcelona, Spain
| | - Jenaro A. Fernández-Valencia
- Department of Orthopedics and Trauma Surgery, Hospital Clinic of
Barcelona, University of Barcelona, Barcelona, Spain
| | - Juan C. Martínez-Pastor
- Department of Orthopedics and Trauma Surgery, Hospital Clinic of
Barcelona, University of Barcelona, Barcelona, Spain
| | - Álex Soriano
- Department of Infectious Diseases, Hospital Clinic of Barcelona,
University of Barcelona, Barcelona, Spain
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Ren W, Zhang J, Chen Y, Wen M, Su Y, Zhao Y, Lu S, Wu J. Evaluation of Coagulation, Fibrinolysis and Endothelial Biomarkers in Cirrhotic Patients With or Without Portal Venous Thrombosis. Clin Appl Thromb Hemost 2021; 26:1076029620982666. [PMID: 33356499 PMCID: PMC7768576 DOI: 10.1177/1076029620982666] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
To evaluate variations in coagulation, fibrinolysis and endothelial marker expression in cirrhotic patients and to explore their clinical value and predictive performance in cirrhotic patients with or without portal vein thrombosis (PVT), we performed a case-control study with 175 cirrhotic patients and 50 healthy individuals. 99 patients had PVT and another 76 patients did not. All participants were evaluated for plasma levels of conventional hemostatic markers. Thrombin-antithrombin complex (TAT), plasmin-α2-plasmin inhibitor complex (PIC), thrombomodulin (TM), tissue plasminogen activator inhibitor complex (t-PAIC), von Willebrand factor antigen (vWF: Ag) and coagulation factor Ⅷ (FⅧ: c) were also assessed and the ratio of TAT/t-PAIC was calculated. We analyzed differences in these biomarkers among the three groups and constructed receiver operating characteristic (ROC) curves. Patients with PVT exhibited significantly higher TAT and TAT/t-PAIC than cirrhotic patients without PVT (both P < 0.001). Areas under the curve (AUC) of ROC analyses for TAT and TAT/t-PAIC were 0.68 and 0.66, the cut-off levels were 1.55 ng/ml and 0.46, with sensitivities and specificities of 78.79% and 51.32% regarding TAT, 39.8% and 90.79% regarding TAT/t-PAIC. Levels of FⅧ: c and vWF: Ag in patients with PVT were significantly lower than those without PVT (p = 0.026 and p = 0.027, respectively). The AUCROC, cut-off level, sensitivity and specificity of FⅧ: c were 0.64, 111.1%, 66.67% and 60%, respectively. For vWF: Ag they were 0.61, 429%, 89.66% and 38.71%, respectively. Cirrhotic patients have disorders of coagulation, fibrinolysis and the endothelial system. TAT, TAT/t-PAIC, FⅧ: c and vWF: Ag can be used as potential biomarkers for predicting PVT in cirrhotic patients.
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Affiliation(s)
- Wenhua Ren
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Jing Zhang
- Department of Hepatology, Beijing Youan Hospital, Capital Medical University, Beijing, China
| | - Yuying Chen
- Department of Laboratory Medicine, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
| | - Meng Wen
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Yu Su
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Yujing Zhao
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Shan Lu
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China
| | - Jun Wu
- Department of Clinical Laboratory, Beijing Jishuitan Hospital, Beijing, China.,Department of Laboratory Medicine, Peking University Fourth School of Clinical Medicine, Beijing Jishuitan Hospital, Xicheng District, Beijing, China
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3
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Pekrul I, Schachtner T, Zwißler B, Möhnle P. [Tranexamic acid: the importance of correct use and individualized risk-benefit analysis]. Anaesthesist 2021; 70:616-617. [PMID: 34115142 DOI: 10.1007/s00101-021-00990-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Isabell Pekrul
- Klinik für Anaesthesiologie, Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie, Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland
| | - Thomas Schachtner
- Anästhesie und Intensivmedizin, Schön Klinik München Harlaching, München, Deutschland
| | - Bernhard Zwißler
- Klinik für Anaesthesiologie, Universität München (LMU), München, Deutschland
| | - Patrick Möhnle
- Klinik für Anaesthesiologie, Abteilung für Transfusionsmedizin, Zelltherapeutika und Hämostaseologie, Universität München (LMU), Marchioninistr. 15, 81377, München, Deutschland.
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Zhang Q, Dong J, Zhou D, Liu F. Circulating D-Dimer versus Fibrinogen in the Diagnosis of Peri-Prosthetic Joint Infection: A Meta-Analysis. Surg Infect (Larchmt) 2021; 22:200-210. [PMID: 32345131 DOI: 10.1089/sur.2019.298] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Circulating D-dimer and fibrinogen are both emerging as promising biomarkers for the diagnosis of peri-prosthetic joint infection (PJI), but their clinical values still remain disputable. This study aims to evaluate and compare the accuracy of circulating D-dimer and fibrinogen in the diagnosis of suspected PJI. Methods: We conducted a comprehensive literature search in PubMed, EMBASE, and the Cochrane Library to retrieve diagnostic accuracy studies in which PJI was investigated with circulating D-dimer or fibrinogen from the time of database inception to August 1, 2019. The pooled sensitivity, specificity, likelihood ratios and diagnostic odds ratio (DOR), summary receiver operating characteristic (sROC) curves, and area under the sROC curve (AUC) were constructed using a meta-analysis framework. Results: Seven eligible studies (1,374 patients) were included in the quantitative analysis. The mean levels of circulating D-dimer and fibrinogen were all significantly higher in patients with PJI. The plasma fibrinogen illustrated relatively higher sensitivity (0.84, 95% confidence interval [CI]: 0.78-0.98) and specificity (0.80, 95% CI: 0.76-0.84) than circulating D-dimer (0.74, 95% CI: 0.69-0.78; 0.66, 95% CI: 0.62-0.69, respectively) for the diagnosis of PJI. The pooled DOR of D-dimer, fibrinogen, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) to diagnose PJI was 7.00 (95% CI, 2.50-19.59), 12.40 (95% CI, 5.85 to 26.28), 10.71 (95% CI, 7.76 to 14.78) and 16.22 (95% CI 11.71-22.46), respectively, while the pooled AUC was 0.84 (95% CI, 0.77-0.90), 0.87 (95% CI, 0.85-0.89), 0.82 (95% CI, 0.78-0.85) and 0.87 (95% CI, 0.86-0.88), respectively. Conclusions: This meta-analysis reveals that it could be concluded that plasma fibrinogen is an excellent biomarker for diagnosing PJI, comparable to serum CRP and ESR, while the diagnostic value of circulating D-dimer is only moderate. Large-scale, prospective studies are still needed to confirm current findings.
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Affiliation(s)
- Qingyu Zhang
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, Shandong, China
| | - Jinlei Dong
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, Shandong, China
| | - Dongsheng Zhou
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, Shandong, China
| | - Fanxiao Liu
- Department of Orthopaedics, Shandong Provincial Hospital affiliated to Shandong University, Shandong, China
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Cheng Y, Liu J, Su Y, Zhao H, Zhao Y, Wen M, Lu S, Zhang W, Wu J. Clinical Impact of Coagulation and Fibrinolysis Markers for Predicting Postoperative Venous Thromboembolism in Total Joint Arthroplasty Patients. Clin Appl Thromb Hemost 2020; 25:1076029619877458. [PMID: 31608652 PMCID: PMC6900621 DOI: 10.1177/1076029619877458] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
One common complication after joint arthroplasty is venous thromboembolism (VTE).
Therefore, it is essential to measure the changes in coagulation and fibrinolysis in order
to predict VTE among patients who underwent joint arthroplasty. This study aimed to
identify potential useful biomarkers for prognosing to VTE. This was a prospective cohort
study enrolling 83 patients who underwent joint arthroplasty. The levels of
d-dimer, thrombin–antithrombin complex (TAT), plasmin–α2-antiplasmin complex
(PIC), soluble thrombomodulin, and tissue plasminogen activator inhibitor complex were
measured on day 0 (before surgery) and days 1, 3, and 6 after surgery. Ultrasound
examination was used to diagnose VTE on preoperative day 0 and postoperative day 6. A
total of 35 patients developed VTE after surgery. Patients with VTE exhibited
significantly higher levels of d-dimer and TAT on postoperative days 3 and 6 (all
P < .05). The area under curves (AUC) of receiver operating
characteristic (ROC) were 0.65 and 0.68 and 0.68 and 0.74 for d-dimer and TAT
levels on postoperative days 3 and 6, respectively. The level of TAT/PIC ratio on
postoperative day 6 was significantly increased among patients with VTE compared to
non-VTE patients (P < .0001). In addition, the AUC of ROC, cutoff
level, sensitivity, specificity, positive-predictive value, and negative-predictive value
of TAT/PIC ratio were 0.78, 4.03 ng/TU, 97.14%, 33.33%, 51.52%, and 94.12%, respectively.
The high sensitivity and negative predictive value of TAT/PIC ratio make it a potential
prognostic index for diagnosing VTE during the early phase of postoperative joint
arthroplasty.
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Affiliation(s)
- Yuying Cheng
- Department of laboratory medicine, Peking University Fourth School of
Clinical Medicine, Beijing, China
| | - Jian Liu
- Adult reconstruction department, Beijing Jishuitan Hospital, Beijing,
China
| | - Yu Su
- Department of laboratory medicine, Beijing Jishuitan Hospital, Beijing,
China
| | - Huiru Zhao
- Department of laboratory medicine, Beijing Jishuitan Hospital, Beijing,
China
| | - Yujing Zhao
- Department of laboratory medicine, Beijing Jishuitan Hospital, Beijing,
China
| | - Meng Wen
- Department of laboratory medicine, Beijing Jishuitan Hospital, Beijing,
China
| | - Shan Lu
- Department of laboratory medicine, Beijing Jishuitan Hospital, Beijing,
China
| | - Wenjie Zhang
- Department of laboratory medicine, Peking University Fourth School of
Clinical Medicine, Beijing, China
| | - Jun Wu
- Department of laboratory medicine, Peking University Fourth School of
Clinical Medicine, Beijing, China
- Jun Wu, Peking University Fourth School of Clinical
Medicine, Beijing 100035, China.
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6
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Xu H, Xie J, Huang Q, Lei Y, Zhang S, Pei F. Plasma Fibrin Degradation Product and D-Dimer Are of Limited Value for Diagnosing Periprosthetic Joint Infection. J Arthroplasty 2019; 34:2454-2460. [PMID: 31155460 DOI: 10.1016/j.arth.2019.05.009] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 04/18/2019] [Accepted: 05/04/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although the Musculoskeletal Infection Society introduced the use of erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) as inflammatory markers for diagnosing periprosthetic joint infection (PJI), no single blood marker reliably detects infection before revision arthroplasty. We therefore posed 2 questions: (1) Are fibrin degradation product (FDP) and D-dimer of value for diagnosing PJI before revision arthroplasty? (2) What are their sensitivity and specificity for that purpose? METHODS To answer these questions, we retrospectively enrolled 318 patients (129 with PJI [group A], 189 with aseptic mechanical failure [group B]) who underwent revision arthroplasty during 2013-2018. Receiver operating characteristic curves were used to determine maximum sensitivity and specificity of the 2 markers. Inflammatory and fibrinolytic markers were evaluated based on (1) the Tsukayama-type infection present and (2) the 3 most common PJI-related pathogens. RESULTS FDP and D-dimer levels were higher in group A than in group B: 4.97 ± 2.83 vs 4.14 ± 2.67 mg/L and 2.14 ± 2.01 vs 1.51 ± 1.37 mg/L fibrinogen equivalent units (FEU), respectively (both P < .05). Based on the Youden index, 2.95 mg/L and 1.02 mg/L FEU are the optimal FDP and D-dimer predictive cutoffs, respectively, for diagnosing PJI. Sensitivity and specificity, respectively, were 65.12% and 60.33% (FDP) and 68.29% and 50.70% (D-dimer). ESR, CRP, and interleukin-6 values were diagnostically superior to those of FDP and D-dimer. CONCLUSION The value of plasma FDP and D-dimer for diagnosing PJI is limited compared with traditional inflammatory markers (ESR, CRP, interleukin-6) before revision arthroplasty.
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Affiliation(s)
- Hong Xu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Jinwei Xie
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Qiang Huang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Yiting Lei
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
| | - Shaoyun Zhang
- Department of Orthopedics, The Third Hospital of Mianyang, Mianyang, People's Republic of China
| | - Fuxing Pei
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Chengdu, People's Republic of China
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7
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Leer-Salvesen S, Dybvik E, Engesaeter LB, Dahl OE, Gjertsen JE. Low-molecular-weight heparin for hip fracture patients treated with osteosynthesis: should thromboprophylaxis start before or after surgery? An observational study of 45,913 hip fractures reported to the Norwegian Hip Fracture Register. Acta Orthop 2018; 89:615-621. [PMID: 30328746 PMCID: PMC6300732 DOI: 10.1080/17453674.2018.1519101] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Controversies exist regarding thromboprophylaxis in orthopedic surgery. We studied whether the thromboprophylaxis in hip fracture patients treated with osteosynthesis should start preoperatively or postoperatively. Data were extracted from the nationwide Norwegian Hip Fracture Register (NHFR). The risks of postoperative deaths, reoperations, and intraoperative bleeding were studied within 6 months after surgery. Patients and methods - After each operation for hip fracture in Norway the surgeon reports information on the patient, the fracture, and the operation to the NHFR. Cox regression analyses were performed with adjustments for age group, ASA score, sex, duration of surgery, and year of surgery. During the period 2005-2016, 96,599 hip fractures were reported to the register. Only osteosyntheses where low-molecular-weight heparin (LMWH) were given and with known information on preoperative start of the prophylaxis were included in the analyses. Dalteparin and enoxaparin were used in 58% and 42% of the operations respectively (n = 45,913). Results - Mortality (RR =1.01, 95% CI 0.97-1.06) and risk of reoperation (RR =0.99, CI 0.90-1.08) were similar comparing preoperative and postoperative start of LMWH. Postoperative start reduced the risk of intraoperative bleeding complications compared with preoperative start (RR =0.67, CI 0.51-0.90). Interpretation - The initiation of LMWH did not influence the mortality or the risk of reoperation in hip fracture patients treated with osteosynthesis. Postoperative start of LMWH could possibly decrease the risk of intraoperative bleeding.
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Affiliation(s)
- Sunniva Leer-Salvesen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; ,Correspondence:
| | - Eva Dybvik
- Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Lars B Engesaeter
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; ,Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
| | - Ola E Dahl
- Innlandet Hospital Trust, Elverum, Norway; ,Thrombosis Research Institute, London, UK
| | - Jan-Erik Gjertsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; ,Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway;
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Li ZJ, Zhao MW, Zeng L. Additional Dose of Intravenous Tranexamic Acid after Primary Total Knee Arthroplasty Further Reduces Hidden Blood Loss. Chin Med J (Engl) 2018. [PMID: 29521284 PMCID: PMC5865307 DOI: 10.4103/0366-6999.226884] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background Total knee arthroplasty (TKA) is the most frequently performed procedure in treating advanced knee osteoarthritis. Excessive perioperative blood loss can sometimes lead to postoperative anemia. Tranexamic acid (TXA) is a potent fibrinolysis inhibitor which has been extensively used at the surgical incision and closure to lower overall blood loss in adult reconstruction surgery. Our previous study suggested that about two-thirds of the total blood loss (TBL) came from hidden blood loss (HBL) on postoperative days 1 and 2. The role of reducing HBL with TXA administration in postoperative TKA patients is unknown. The current study was designed to evaluate the efficiency and safety of supplemental intravenous (IV) TXA in further reducing HBL after primary TKA. Methods A prospective pilot study was conducted at a single institution on 43 consecutive patients who underwent unilateral TKA from September 2014 to February 2015. All patients were given 1 g of IV TXA 10-15 min before operation and another 1 g of IV TXA at the time of wound closure on the day of surgery. On postoperative days 1 and 2, the supplemental group (n = 21) was given additional 1 g of TXA intravenously twice a day, whereas the control group (n = 22) received an equal volume of saline. Drain output, hemoglobin (Hb), and hematocrit (HCT) were recorded preoperatively and 5 consecutive days postoperatively in both groups. HBL was calculated with the Gross formula. Pre- and post-operative lower extremity Doppler venous ultrasound was performed in all patients to detect deep vein thrombosis (DVT). The indexes were compared using the Mann-Whitney test, whereas the results of Hb and HCT were analyzed by repeated-measures analysis of variance. The difference was considered statistically significant if P < 0.05. Results The demographics and surgical characteristics of the two groups were comparable. Supplemental group had higher Hb level on postoperative days 1-5 compared to the control; however, the difference was not significant (F = 2.732, P = 0.106). The HCT of the supplemental group was significantly higher than that of the control group on postoperative day 5 (F = 5.254, P = 0.027). No significant difference was found in drainage volume and TBL, but the HBL was reduced in the supplemental group (supplemental 133.1 [71.8, 287.3] ml and control 296.0 [185.3, 421.4] ml, Z = 2.478, P = 0.013, median [interquartile range]). There was one DVT in the control group and none in the supplemental group. All patients were followed at 1 year after surgery, and no further complications were reported. Conclusion Based on the current study, additional doses of IV TXA could potentially further reduce HBL after primary TKA without increasing the risk of venous thromboembolism.
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Affiliation(s)
- Zi-Jian Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China
| | - Min-Wei Zhao
- Department of Orthopaedics, Peking University Third Hospital, Beijing 100191, China
| | - Lin Zeng
- Research Center of Clinical Epidemiology, Peking University Third Hospital, Beijing 100191, China
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Stoicea N, Moran K, Mahmoud AR, Glassman A, Ellis T, Ryan J, Granger J, Joseph N, Salon N, Ackermann W, Rogers B, Niermeyer W, Bergese SD. Tranexamic acid use during total hip arthroplasty: A single center retrospective analysis. Medicine (Baltimore) 2018; 97:e10720. [PMID: 29794747 PMCID: PMC6392984 DOI: 10.1097/md.0000000000010720] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tranexamic acid (TXA) is an antifibrinolytic agent that has shown promise in reducing blood loss during total hip arthroplasty (THA). Several studies have reported side effects of high-dose TXA administration, including myocardial infarction (MI), thromboembolic events, and seizures. These possible side effects have prevented the widespread adoption of TXA in the surgical community. METHODS We conducted a retrospective chart review of 564 primary and revision THAs performed at a single academic center. Surgical patients received either no TXA or 1 g IV TXA at the beginning of surgery followed by a second bolus just before the surgical wound closure, at the surgeon's discretion. We analyzed differences in hemoglobin (Hb), hematocrit (Hct), estimated blood loss (EBL), and adverse events in patients receiving TXA versus patients not receiving TXA up to 2 days following surgery. RESULTS Significantly higher Hb and Hct values were found across all time points among patients undergoing primary posterior or revision THA who had received TXA. In addition, transfusion rates were significantly decreased in both primary posterior THAs and revision THAs when TXA was administered. Patients who received TXA experienced significantly fewer adverse events than those who did not for all surgery types. CONCLUSION Administration of low-dose intravenous (IV) and intra-articular (IA) TXA does not appear to increase rates of adverse events and may be effective in minimizing blood loss, as reflected by Hb and Hct values following THA.
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Affiliation(s)
| | | | - Abdel-Rasoul Mahmoud
- Center for Biostatistics, Department of Biomedical Informatics, The Ohio State University, Columbus, OH
| | - Andrew Glassman
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus
| | | | - John Ryan
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus
| | - Jeffrey Granger
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus
| | | | - Nathan Salon
- Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL
| | | | | | | | - Sergio D. Bergese
- Department of Anesthesiology
- Department of Neurological Surgery, The Ohio State University Wexner Medical Center, Columbus, OH
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10
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Luo C, Luo X, He Y, Li J, Huang B, Lin L, Li Q. Impact of postoperative drainage autologous blood re-transfusion on the coagulation parameters and D-dimer levels of patients after total hip arthroplasty. Transfus Apher Sci 2016; 55:109-13. [PMID: 27118495 DOI: 10.1016/j.transci.2016.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/18/2016] [Accepted: 04/08/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Postoperative drainage autologous blood re-transfusion (ABT) is an important treatment method that maintains a high haemoglobin (HGB) content and obviates the need for allogeneic blood transfusion in patients after surgery. However, the safety of ABT remains controversial. OBJECTIVES AND METHODS This study aimed to investigate the safety of postoperative drainage ABT in primary total hip arthroplasty (THA). In this randomized, controlled study, patients undergoing THA were selected and randomly divided into two groups. A device for postoperative ABT was used for the 49 patients in the ABT group, whereas conventional postoperative vacuum drainage was used for the 42 patients in the drainage blood (Drain) group without ABT. The coagulation parameters and D-dimer (DD) levels of the two groups of patients were recorded before surgery (T0) and on postoperative days one (T1), three (T2), seven (T3), and 14 (T4). RESULTS A within-group comparison after THA showed that the postoperative fibrinogen (FIB) and DD levels were higher than those before surgery in both groups (P < 0.01). A between-group comparison showed that, at different time points, the postoperative drainage blood amount and the coagulation parameters were not significantly different between the two groups. Compared with the Drain group, the DD levels in the ABT group were significantly higher at T1, T2, and T3 (P < 0.05). CONCLUSION Postoperative drainage ABT did not significantly impact the coagulation parameters of patients after THA. However, the DD levels after ABT significantly increased, which may affect the risk of thrombosis.
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Affiliation(s)
- Cheng Luo
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China; Department of Joint Surgery, Panyu Central Hospital, Guangzhou 511400, China
| | - Xiangping Luo
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Yingyi He
- Department of Anesthesiology, Panyu Central Hospital, Guangzhou 511400, China
| | - Jiewen Li
- Department of Joint Surgery, Panyu Central Hospital, Guangzhou 511400, China
| | - Bingsheng Huang
- Department of Joint Surgery, Panyu Central Hospital, Guangzhou 511400, China
| | - Lijun Lin
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China
| | - Qi Li
- Department of Orthopedics, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, Guangdong Province, China.
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Burleson A, Guler N, Banos A, Syed D, Wanderling C, Hoppensteadt D, Rees H, Fareed J, Hopkinson W. Perioperative Factors and Their Effect on the Fibrinolytic System in Arthroplasty Patients. Clin Appl Thromb Hemost 2015; 22:274-9. [PMID: 26460335 DOI: 10.1177/1076029615611251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Total joint arthroplasty (TJA) patients are mostly of advanced age and with comorbidities such as increased body mass index (BMI) and impaired glucose tolerance. These factors and type of surgery may affect the fibrinolytic system. AIM To investigate the effect of age, sex, BMI, type of surgery, and tranexamic acid (TXA) treatment on the fibrinolytic system in TJA patients. METHODS Ninety-nine patients undergoing TJA (32 total hip arthroplasty [THA] and 67 total knee arthroplasty [TKA]) were included in this study. Blood samples were drawn at preoperative clinic appointments and on postoperative day 1. Antigenic levels of d-dimer, plasminogen activator inhibitor 1 (PAI-1), and tissue plasminogen activator (tPA) were measured using a commercially available enzyme-linked immunosorbent assay kit. Antiplasmin activity was measured using functional method. Age, gender, hemoglobin (Hb) levels, and BMI were collected from the records. RESULTS Preoperative d-dimer and tPA levels were positively correlated with age, whereas preoperative antiplasmin was negatively correlated with age. Body mass index was only associated with preoperative tPA levels. There was no significant difference in postoperative levels of d-dimer, PAI-1, tPA, or antiplasmin between patients treated with TXA or without TXA. Percentage change in d-dimer and tPA showed significantly lower values in patients treated with TXA compared to the nontreated group. Type of surgery did not affect the fibrinolytic markers. CONCLUSION These results confirm that advanced age and elevated BMI positively contribute to fibrinolytic dysregulation in TJA patients, whereas TXA seems to decrease the fibrinolytic activity.
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Affiliation(s)
- Andrew Burleson
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Nil Guler
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Andrew Banos
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Daneyal Syed
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | | | - Debra Hoppensteadt
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Harold Rees
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - William Hopkinson
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
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Guler N, Burleson A, Syed D, Banos A, Hopkinson W, Hoppensteadt D, Rees H, Fareed J. Fibrinolytic Dysregulation in Total Joint Arthroplasty Patients. Clin Appl Thromb Hemost 2015. [DOI: 10.1177/1076029615597060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: The alterations of the fibrinolytic components in osteoarthritic joint disease and their postsurgical modulation are not clearly understood. Preexisting hemostatic dysfunction may lead to both thrombotic and bleeding events in these patients. Aim: To profile fibrinolytic parameters in patients undergoing total joint arthroplasty prior to and on postoperative day 1. Methods: A total of 98 total joint arthroplasty patients were included in this study. Blood samples were drawn preoperatively and on postoperative day 1 status posttotal knee or total hip arthroplasty surgery. d-Dimer, plasminogen activator inhibitor 1 (PAI-1), and tissue plasminogen activator (tPA) were measured using commercially available enzyme-linked immunosorbent assay kits. Antiplasmin activity was measured by using a functional method. Results: Preoperative PAI-1, d-dimer, and tPA levels were significantly higher in arthroplasty patients compared to healthy controls. Preoperative antiplasmin level was lower than controls. Postoperative levels of PAI-1 and d-dimer were increased compared to preoperative values. Postoperative antiplasmin values were lower than preoperative levels. Changes in tPA was not significant. There was no correlation between preoperative PAI-1 and d-dimer levels. Pre- and postoperative percentage changes in each individual were calculated for PAI-1, d-dimer, tPA, and antiplasmin. There was a positive correlation between d-dimer and PAI-1. Negative correlations between antiplasmin and d-dimer and between antiplasmin and PAI-1 were noted. Conclusion: These results confirm the perturbation in the fibrinolytic system of patients undergoing total joint arthroplasty surgery. Surgical intervention may also enhance the observed changes. The alterations in the fibrinolytic system may lead to the observed hemostatic complications such as bleeding, hematoma formation, or potential need for blood transfusion.
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Affiliation(s)
- Nil Guler
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Andrew Burleson
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Daneyal Syed
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Andrew Banos
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - William Hopkinson
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Debra Hoppensteadt
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA
| | - Harold Rees
- Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA
| | - Jawed Fareed
- Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA
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Yu Y, Wu J, Zhao W, Zhao L, Zhu C, Gao X. Calibrated automated thrombography for monitoring coagulation function in patients with intracerebral haemorrhage. J Int Med Res 2015; 43:316-25. [PMID: 25947643 DOI: 10.1177/0300060514565801] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 12/05/2014] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To monitor coagulation function in patients with intracerebral haemorrhage (ICH) using calibrated automated thrombography. METHODS Patients admitted to hospital with ICH (confirmed within 18 h of symptom onset) were enrolled. Patient history and blood samples were obtained within 6 h of admission; further blood samples were collected on days 4, 8 and 15 (or on discharge between days 9-15: grouped with day 15 data). Blood samples were also collected from age- and sex-matched healthy controls. All samples underwent calibrated automated thrombography. RESULTS At admission, thrombin lag time and time to peak was longer, and endogenous thrombin potential and peak height were lower, in patients with ICH (n = 20) than in healthy controls (n = 29). Lag time in patients with ICH gradually decreased, but remained significantly longer than in controls until day 8. Time to peak also gradually decreased, but remained longer in patients than in controls by day 15. Endogenous thrombin potential and peak height gradually increased in patients, but remained lower than in controls on day 15. CONCLUSIONS Patients with ICH have poorer coagulation function than healthy individuals, but this function gradually recovers during hospitalization.
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Affiliation(s)
- Yao Yu
- Department of Neurology, Peking University People's Hospital, Beijing, China
| | - Jun Wu
- Medical Laboratory, Peking University Jishuitan Hospital, Beijing, China
| | - Wei Zhao
- Department of Neurology, Mancheng County Hospital, Baoding, China
| | - Lei Zhao
- Medical Laboratory, Peking University People's Hospital, Beijing, China
| | - Chunpeng Zhu
- Department of Neurology, Mancheng County Hospital, Baoding, China
| | - Xuguang Gao
- Department of Neurology, Peking University People's Hospital, Beijing, China
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