Perioperative Factors and Their Effect on the Fibrinolytic System in Arthroplasty Patients
Perioperative Factors and Their Effect on the Fibrinolytic System in Arthroplasty Patients
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DOI：
10.1177/1076029615611251
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发表时间：
2016-04-01
影响因子：
2.9
通讯作者：
Hopkinson, William
中科院分区：
文献类型：
--
作者：
Burleson, Andrew;Guler, Nil;Hopkinson, William
背景资料：全关节置换术（TJA）患者大多年龄较大，并伴有体重指数（BMI）升高和葡萄糖耐量受损等合并症。目的：探讨年龄、性别、体重指数、手术方式及氨甲环酸（TXA）治疗对TJA患者纤溶系统的影响。方法：99例TJA患者（32例全髋关节置换术[THA]，67例全膝关节置换术[TKA]）纳入本研究。在术前门诊预约和术后第1天采集血样。使用市售酶联免疫吸附测定试剂盒测量D-二聚体、纤溶酶原激活物抑制剂1（派-1）和组织纤溶酶原激活物（tPA）的抗原水平。抗纤溶酶活性用功能法测定。年龄，性别，血红蛋白（Hb）水平，BMI从records.Results收集：术前D-二聚体和tPA水平与年龄呈正相关，而术前抗纤溶酶与年龄呈负相关。体重指数仅与术前tPA水平相关。在接受TXA或未接受TXA治疗的患者之间，术后d-二聚体、派-1、tPA或抗纤溶酶水平无显著差异。与未治疗组相比，接受TXA治疗的患者d-二聚体和tPA的百分比变化值显著降低。手术类型不影响纤溶指标。结论：这些结果证实，高龄和BMI升高的TJA患者纤溶功能失调，而血栓素A似乎降低纤溶活性。
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.