Dysregulation of Tissue Factor, Thrombin-Activatable Fibrinolysis Inhibitor, and Fibrinogen in Patients Undergoing Total Joint Arthroplasty.
Dysregulation of Tissue Factor, Thrombin-Activatable Fibrinolysis Inhibitor, and Fibrinogen in Patients Undergoing Total Joint Arthroplasty.
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DOI：
10.1177/1076029617700998
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发表时间：
2017-11
期刊：
影响因子：
--
通讯作者：
Fareed J
中科院分区：
文献类型：
--
作者：
Wanderling C;Liles J;Finkler E;Carlsgaard P;Hopkinson W;Guler N;Hoppensteadt D;Fareed J
髋关节或膝关节的全关节置换术(TJA)已经成为一种越来越常见的手术方式。虽然TJA是一种成功的治疗退行性关节疾病的方法，但众所周知，TJA最常见的围术期并发症之一是深静脉血栓形成(DVT)。分析TJA患者的组织因子(TF)、微粒子组织因子(MP-TF)、凝血酶激活的纤溶抑制物(TAFI)和纤维蛋白原水平，以确定潜在的潜在止血失调。对接受TJA手术的患者在手术前1天和手术后1天采集未确认的血液样本。血浆样本用酶联免疫吸附分析试剂盒分析纤维蛋白原、TAFI、Tf和MP-Tf；纤维蛋白原水平也用基于凝块的活性分析来评估。与健康对照组比较，术前、术后患者纤维蛋白原和MP-TF水平显著升高，而TF和TAFI水平显著降低。比较手术前和术后的患者，没有发现显著的差异；然而，有趣的是，与对照组相比，手术干预加剧了术前样本中发现的变化。这项研究的结果证实，接受TJA的患者已经存在纤溶系统的改变。外科干预往往会加剧这些变化。这项研究中观察到的变化可能为TJA与DVT和血栓栓塞症的较高发生率相关提供洞察力。
Total joint arthroplasty (TJA) of the hip or knee (THA, TKA) has become an increasingly common procedure. While TJA is a successful treatment for individuals experiencing degenerative joint diseases, it is well known that one of the most common perioperative complications of TJA is deep venous thrombosis (DVT). To profile tissue factor (TF), microparticle-tissue factor (MP-TF), thrombin-activatable fibrinolysis inhibitor (TAFI), and fibrinogen levels in patients undergoing TJA to determine potential preexisting Hemostatic dysregulation. De-identified blood samples were obtained from patients undergoing TJA 1 day pre- and 1 day postprocedure. Plasma samples were analyzed using enzyme-linked immunosorbent assay kits for fibrinogen, TAFI, TF, and MP-TF; fibrinogen levels were also assessed using a clot-based activity assay. In comparison with healthy controls, there were significant increases of fibrinogen and MP-TF levels, while there were significant decreases in TF and TAFI levels in the preoperative and postoperative patients. Comparing the pre versus postoperative patients, no significant differences were found; interestingly, however, surgical intervention exacerbated the changes found in the preoperative samples compared to the controls. The results of this study confirm that patients undergoing TJA have preexisting alterations in the fibrinolytic system. Surgical intervention tended to exacerbate these changes. The alterations observed in this study may provide insight as to why TJA is associated with higher rates of DVT and thromboembolism.
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