Abstract
The aim of the present study was to investigate aspects of coagulation and fibrinolysis
during knee arthroplasties in order to find out 1. whether an increased fibrinolysis
is correlated to an increased blood loss 2. whether there is a difference in markers
for coagulation and fibrinolysis in peripheral venous blood compared to those in blood
from the wounds 3. whether the administration of tranexamic acid modifies the fibrinolytic
response. Twenty-four patients were included. Twelve patients were given tranexamic
acid intravenously at the end of the operation. The dose was repeated three hours
later. The other 12 patients were given an equivalent amount of placebo. The administration
was randomised and double-blind. Levels of prothrombin fragments 1+2, D-dimers, plasminogen,
α2-antiplasmin, tissue plasminogen activator (tPA), and plasminogen activator inhibitor
(PAI-1) in venous blood were investigated just before the operation, at the end of
the operation and three hours later. At the end of the operation blood for analysis
was also drawn from the wound. Coagulation and fibrinolysis was activated during and
after surgery. The activation was significantly higher in blood from the wounds than
in peripheral venous blood. We found no direct correlation between the degree of fibrinolysis
and blood loss. The administration of tranexamic acid reduced fibrinolysis in the
wounds but not in peripheral venous blood. The postoperative blood loss was reduced
by half. Copyright © 1997 Elsevier Science Ltd
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Thrombosis ResearchAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- The response of the fibrinolytic system in trauma.Acta Chir Scand Suppl. 1985; 522: 245-271
- The postoperative fibrinolytic shutdown: a rapidly reverting acute phase pattern for the fast-acting inhibitor of tissue-type plasminogen activator after trauma.Scand J Clin Lab Invest. 1985; 45: 605-610
- Hemostatic changes and postoperative deep-vein thrombosis associated with the use of a pneumatic tourniquet.J Bone Joint Surg. 1981; 63A: 461-465
- Changes in circulatory indices of thrombosis and fibrinolysis during total knee arthroplasty performed under tourniquet.J Arthroplast. 1995; 10: 523-528
- Hemostatic effects of tranexamic acid and desmopressin during cardiac surgery.Circulation. 1991; 84: 2063-2070
- High-dose aprotinin reduces blood loss in patients undergoing total hip replacement surgery.Anesthesiology. 1994; 80: 23-29
- Does tranexamic acid reduce blood loss in knee arthroplasty.Am J Knee Surg. 1995; 8: 88-92
- Fibrinolytic inhibition with tranexamic acid reduces blood loss and blood transfusions in total knee arthroplasty. A prospective, randomised, double-blind study of 86 patients.J Bone Joint Surg. 1996; 78-B: 434-440
- Tranexamic acid (cyklokapron) reduces perioperative blood loss associated with total knee arthroplasty.Br J Anaesth. 1995; 75: 534-537
ERIKSSON B.I. Thromboembolism after total hip replacement. Relationship to the fibrinolytic system. Thesis. Göteborg University, Göteborg, Sweden, 1991.
- Effects on coagulation and fibrinolysis of desmopressin in patients undergoing total hip replacement.Thromb Haemost. 1991; 66: 652-656
- A critical review of the evidence supporting a relationship between impaired fibrinolytic activity and venous thromboembolism.Arch Intern Med. 1991; 151: 1721-1731
- Influence of gender, age and sampling time on plasma fibrinolytic variables and fibrinogen. A population study.Fibrinolysis. 1993; 7: 316-323
- Measurement of plasminogen activator inhibitor 1 in biological fluids with a murine monoclonal antibody-based enzyme-linked immunosorbent assay.Blood. 1988; 71: 220-225
- Application of pharmacokinetic data from healthy volunteers for the prediction of plasma concentrations of tranexamic acid in surgical patients.Clin Drug Invest. 1995; 10: 280-287
- Antifibrinolytic therapy with cyklokapron in connection with prostatectomy. A double blind study.Scand J Urol Nephrol. 1969; 3: 177-182
OGSTON G, MACDONALD G.A, FULLERTON H.W. The influence of anxiety in tests of blood coagulability and fibrinolytic activity. Lancet ii, 521–23, 1962.
- The physiological aspects of fibrinolysis.Thromb Res. 1994; 76: 1-31
- Effects of psychosocial stress on the fibrinolytic system in man.Fibrinolysis. 1990; 4: 110-112
- Role of extradural and of general anaesthesia in fibrinolysis and coagulation after total hip replacement.Br J Anaesth. 1983; 55: 625-629
- Hemostatic effects of stress hormone infusion.Anesthesiology. 1994; 81: 1116-1126
- Influence of ageing on the activity of the hemostatic system: prothrombin fragment 1+2, thrombin-antithrombin III complexes and D-dimers in 80 healthy subjects with age ranging from 20 to 94 years.Nouv Rev Fr Hematol. 1992; 34: 43-46
- Daytime fluctuations in blood of tissue-type plasminogen activator (tPA) and its fast-acting inhibitor (PAI-1).Thromb Haemostas. 1988; 59: 329-332
- Sequential intrapulmonary and systemic activation of coagulation and fibrinolysis during and after total hip replacement surgery.Thromb Res. 1993; 70: 451-458
- The dose-response relationship of tranexamic acid.Anesthesiology. 1995; 82: 383-392
- Incidence of thrombosis associated with epsilon-aminocaproic acid administration and with combined epsilon-aminocaproic acid and subcutaneous heparin therapy.Acta Chir Scand. 1968; 134: 343-349
- Treatment with the fibrinolytic inhibitor tranexamic acid - risk for thrombosis.Acta Obstet Gynecol Scand. 1990; 69: 353-354
- The effect of the fibrinolytic inhibitor epsilon-aminocaproic acid on the incidence of deep-vein thrombosis after prostatectomy.Brit J Surg. 1972; 59: 522-524
HEDLUND P.O. Postoperative venous thrombosis in benign prostatic disease. Scand J Urol. Nephrol Suppl 27, 1975.
- Treatment with tranexamic acid during pregnancy and the risk of thrombo-embolic complications.Thromb Haemostas. 1993; 70: 238-240
- The effect of tranexamic acid on the fibrinolytic activity of vein walls.Ann Chir Gynaecol. 1978; 67: 203-205
Article info
Publication history
Accepted:
November 21,
1996
Received in revised form:
November 21,
1996
Received:
August 7,
1996
Identification
Copyright
© 1997 Elsevier Science Ltd. Published by Elsevier Inc. All rights reserved.
