Hypofibrinolytic Activity after Total Joint Replacement

Abstract

Tissue-type plasminogen activator (t-PA), tissue-type plasminogen activator inhibitor (t-PAI), and other factors (platelets, fibrinogen, fibrinogen degradation products, antithrombin-III, plasminogen, and α 2 -plasmin inhibitor [α 2 -PI]) related to the fibrinolytic system were studied in 21 patients undergoing total joint replacement.Seventeen of the 21 patients revealed an impaired fibrinolytic activity from the first to seventh postoperative day and a subsequent return to the preoperative level by the fourteenth postoperative day. There were accompanying increases in the level of α 2 -PI and in the t-PAI/t-PA ratio, and there was decrease in plasminogen level. Such hypofibrinolytic states may be related to a higher incidence of postoperative thrombosis in total joint replacement patients.

Erythropoietin administration for preoperative autologous blood donation from patients scheduled for orthopedic surgery

“…Thrombus formation, hypertension and other side effects [1,3,12,13] may occur when EPO is administered to patients, and hypofibrinolytic activity has also been noted after total joint replacement [8]. We reported increases in platelet counts and rates of plasminogen activator inhibitor-1 which is involved in the acquisition of autologous blood using EPO [1].…”

“…Fibrinolytic therapy was immediately initiated and their general condition improved. The varicose veins, obesity and fibrinolytic shut down [8] that occurred after the THA may have contributed to the pulmonary embolism.…”

Comparison of intravenous and subcutaneous erythropoietin therapy for preoperative acquisition of blood for autologous transfusion in patients undergoing total arthroplasty

“…Thrombus formation, hypertension, and other side effects can occur when EPO is given to patients with chronic renal failure, 2,3 and hypofibrinolytic activity has also been noted after total joint replacement. 5 To prevent complications after total arthroplasty in patients who have received EPO, we recommend: (1) postoperative fibrinolytic therapy for 2 weeks for patients with varicose veins; (2) administration of nonsteroidal anti-inflammatory drugs; (3) adequate hydration and antibiotics; (4) thorough cleansing and (5) coagulation of the surgical lesion; (6) the use of two suction drainage tubes; (7) a compressive dressing; and (8) early rehabilitation.…”