Course of D‐dimer concentrations after total knee replacement surgery: effect of allogeneic and unwashed drainage blood transfusion

Abstract

SUMMARY Salvage and return of unwashed filtered shed blood (USB) after unilateral total knee replacement (TKR) is a blood‐saving method frequently used to avoid allogeneic blood transfusion (ABT). However, the use of USB is controversial, as it may impair hemostasis when retransfused. We report on 1‐month follow‐up of fibrinolytic activity in TKR patients who received either ABT, USB or no transfusion. One hundred and six consecutive TKR patients entered the study: 88 received no transfusion (group 1), five received ABT (group 2), and 13 received USB (group 3). Blood samples were obtained on day of surgery and postoperative days 1, 7 and 30, and assayed for blood counts, C‐reactive protein (CRP), and D‐dimers. Demographic and clinical data were also collected. There were no differences in demographic data or postoperative infection rate between groups, but length of hospital stay was longer in group 2 (P < 0.05). Postoperative levels of D‐dimers increased on day 1, and remained elevated on day 30 in all groups, but on day 1 they were higher in group 3 (P < 0.05). There were no differences in perioperative levels of CRP between groups, and they correlated with D‐dimers both preoperatively and on day 30. Taken together, these data suggest that surgery for TKR induced an activation of coagulation and fibrinolysis. This situation lasts at least as late as 30 days after surgery, and is not modified by transfusion, except for a transitory induction of fibrinolysis by USB return in the early postoperative period.

Lower limb orthopaedic surgery results in changes to coagulation and non-specific inflammatory biomarkers, including selective clinical outcome measures

“…They reported that increased D-dimer levels following TKR surgery do induce changes in coagulation activity, with these changes not being modified by either allogenic, unwashed drainage or no blood transfusion. In agreement with Muñoz et al [ 16 ], this study demonstrates evidence of increased coagulation activity following TKR surgery, and provides further evidence that similar yet insignificant changes were observed following THR surgery.…”

“…Changes in D-dimer concentrations demonstrate an increased coagulation activity following surgery, with a possible explanation for these changes being that TKR surgery has an intrinsic effect on normal homeostasis, resulting in changes in the coagulation pathways; this may lead to postoperative complications, such as deep vein thrombosis. Muñoz et al [ 16 ] have reported that D-dimer levels increased on day 1 post TKR surgery and remained elevated at day 30 postoperative. They reported that increased D-dimer levels following TKR surgery do induce changes in coagulation activity, with these changes not being modified by either allogenic, unwashed drainage or no blood transfusion.…”

Sedimentation method for preparation of postoperatively salvaged unwashed shed blood in orthopaedic surgery

“…Several studies have shown that USB return did not modify the humoral or cellular response that follows TKR surgery, 11 12 14 but resulted in a transient yet clinically uneventful activation of coagulation and fibrinolysis. 38 As we found that colloid-induced RBC sedimentation removes 75% of plasma and proteins (e.g. total protein, CK, or IL-6); from USB, it is conceivable that it also reduces other biologically active peptides (e.g.…”