Monitoring of fibrinolytic system activity with plasminogen, D-dimers and FDP in primary total knee arthroplasty (TKA) after topical, intravenous or combined administration of tranexamic acid

Abstract

Aim. We assessed various ways of tranexamic acid (TXA) administration on the fibrinolytic system. Blood loss, transfusions, drainage and haematoma were secondary outcomes. Methods. In this prospective study, we examined 100 patients undergoing primary total knee arthroplasty (TKA) between June and November 2018. Patients were randomly assigned to 4 groups according to the following TXA regimens: 1) loading dose 15 mg TXA/kg single intravenous administration applied at initiation of anesthesia (IV1); 2) loading dose 15 mg TXA/kg + additional dose 15 mg TXA/kg 6 h after the first application of TXA (IV2); 3) IV1 regime in combination with a local wash of 2 g of TXA in 50 mL of saline (COMB); 4) topical administration of 2 g of TXA in 50 mL of saline (TOP). Results. Systemic fibrinolysis interference was insignificant in all of the regimens; we did not detect significant differences between IV1, IV2 and COMB in the monitored parameters within the elapsed time after the TKA; IV regimes had the lowest total drainage blood loss; the lowest blood loss was associated with the IV1 and IV2 regimens (IV1, IV2 < COMB < TOP); the lowest incidence of haematomas was in patients treated with TXA topically (i.e., in COMB + TOP). Conclusion. The largest antifibrinolytic effect was associated with intravenous administration of TXA. In terms of blood loss, intravenously administered TXA can interfere with the processes associated with the formation of the fibrin plug more efficiently than the simple washing of wound surfaces with TXA.

Combined and intravenous administration of TXA reduces blood loss more than topical administration in primary total knee arthroplasty: A randomized clinical trial

“…We found no significant postoperative complications associated with TXA administration in this trial, similar to the previous trial on safety of TXA administration 10 . There were no thromboembolic complications in the study groups.…”

“…In our previous study, we determined the safety profile for systemic, combined and topical administration of TXA in patients undergoing primary TKA (ref. 10 ). We found no significant effect on systemic markers of fibrinolysis in either regimen.…”

Impact of Whole-Layer Barbed Suture Closure on the Postoperative Effect and Aesthetic Satisfaction with Incision After Knee Arthroplasty

“…13 The TKA incision is located at the apex of knee flexion and extension, and the tension is much higher than that of a general surgical incision, which results in higher requirements for suture materials and methods. 11 , 12 With the development of nonabsorbable sutures and synthetic absorbable sutures, and with the subsequent maturity and promotion of barbed suture materials, these materials have been widely applied in joint replacement surgery by an increasing number of physicians. The barbed suture has been reported to be safe and efficient in operation, and its strength and surrounding tissue reaction were equivalent to those of traditional absorbable sutures.…”

“…Complete closure and tight suture at all layers with sufficient pulling force are required during suture, which means higher requirements for both suture materials and methods. 11 , 12 Absorbable antibacterial Vicryl and surgical appliance adhesive cannot provide sufficient tension and are prone to exudation or splitting. 13 Meanwhile, a nonabsorbable suture may increase the risk of infection by increasing the number of subcutaneous suture knots, incision dehiscence, nonunion and even infection, which can be disastrous.…”

The significance of coagulation and fibrinolysis-related parameters in predicting postoperative venous thrombosis in patients with breast cancer

“…Thrombomodulin (TM) levels are abnormally up-regulated when the vascular endothelium is damaged, which helps to assess the degree of vascular injury (8). Fibrinogen degradation product (FDP) and D-dimer (D-D) are both functional markers of the fibrinolytic system, and their levels are significantly increased when fibrinolytic activity is enhanced in patients, which can indicate blood coagulation system activity (9,10). These are important markers in the process of venous thrombosis, which can be significantly increased during thrombosis.…”