The postoperative fibrinolytic shutdown: a rapidly reverting acute phase pattern for the fast-acting inhibitor of tissue-type plasminogen activator after trauma

Kluft, C.; Verheijen, J.H.; Jie, A.F.H.; Rijken, D.C.; Preston, F. E.; Sue‐Ling, H. M.; Jespersen, Jørgen; Aasen, Ansgar O.

doi:10.3109/00365518509155267

Cited by 310 publications

(150 citation statements)

References 16 publications

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“…On the other hand, there was no increase in PAP. These observations concur with previous findings that fibrinolytic activity is enhanced intraoperatively with a shutdown after surgery [36]. The postoperative fibrinolytic shutdown was ascribed to a temporary increase in t-PA inhibitor levels after surgery.…”

Section: Discussionsupporting

confidence: 83%

Time course of thrombosis and fibrinolysis during total hip surgery

Reikerås¹,

Clementsen²,

Bjørnsen³

2006

J Orthopaed Traumatol

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Venous thrombosis is common in elective hip surgery, and prophylactic treatment is used up to 12 hours before or after surgery. Recent clinical trials suggested that the timing of initiating prophylaxis significantly influenced the antithrombotic effectiveness. Furthermore, the timing of initiating antifibrinolytic treatment to reduce blood loss has been a question of debate. We studied the time course of coagulation and fibrinolysis at all phases during total hip arthroplasty. Specific markers of thrombosis (prothrombin fragment F1.2) and of fibrinolysis (plasminantiplasmin (PAP) and D-dimer) were examined in eight female and two male patients aged 16–62 years. There was a progressive increase in plasma concentrations of F1.2 during the operation. From the end of operation to 4 hours afterwards, there was no further increase in F1.2. Levels of D-dimer did not change until wound closure, when they began to increase up to 4 hours postoperatively, but there were no changes in PAP during the operation or during the 4-h postoperative period. Therefore, surgery for total hip arthroplasty activates thrombin generation during operation with fibrin degradation at a later stage. These observations harmonize with the notion that the interval between surgery and first administration of antithrombotic treatment is a critical variable.

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Section: Discussionsupporting

confidence: 83%

Time course of thrombosis and fibrinolysis during total hip surgery

Reikerås¹,

Clementsen²,

Bjørnsen³

2006

J Orthopaed Traumatol

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“…18 Along with many possible roles in atherogenesis and atherosclerotic progression, inflammatory mediators can activate coagulation by stimulating monocytes to express tissue factor 19 (as can CRP itself 20 ) and by causing disregulation in natural anticoagulation. 21 They can affect fibrinolytic balance 22 and have been implicated as a possible pathogenetic agent in the development of insulin resistance, 23 the latter being consistent with the ability of inflammation markers to predict the future occurrence of diabetes. 24 As a major source of proinflammatory cytokines, adipose tissue becomes linked at the molecular level to the disregulation of a variety of underlying systems, all of which are causally implicated in the development of atherosclerotic, thrombotic, and metabolic outcomes.…”

Section: See P 961 and 968mentioning

confidence: 94%

Is Visceral Adiposity the “Enemy Within”?

Tracy

2001

ATVB

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"Has it ever struck you that there's a thin man inside every fat man, just as they say there's a statue inside every block of stone?" George Orwell, Coming Up For Air (1939) R ecently, data from diverse areas of investigation have come together to implicate chronic low-level inflammation as an important pathogenetic factor in atherosclerotic cardiovascular disease (CVD). As recently summarized by Ross, 1 studies in cell biology, animal models, clinical research, and epidemiology have been remarkably consistent in validating the early work of Virchow 2 and others, suggesting that atherosclerotic lesions are essentially an inflammatory response. In clinical research and epidemiology, 2 inflammation blood markers in particular, fibrinogen and C-reactive protein (CRP), have been used. Many studies have confirmed that these markers predict future cardiovascular events independently of more traditional cardiovascular risk factors, such as plasma lipid levels. [3][4][5] Because of this, several investigators have suggested that CRP might prove useful in clinical practice, 6,7 whereas others have favored fibrinogen. 8,9 Although there are important details to work out before either of these markers enters the clinical domain, this interest provides a clear and compelling imperative for understanding how inflammation integrates into both normal physiology and atherothrombotic pathophysiology. See p 961 and 968Focusing on CRP, population-based research efforts have revealed that in general, women have slightly higher values than men, blacks have higher values than whites, and those with clinical CVD have higher values than those without [10][11][12][13] et al, manuscript in preparation). In those without clinical CVD, metabolic variables consistently correlated with CRP include body mass index (BMI), glucose tolerance status/diabetes status, and level of coagulation activation. In addition, depending on the population being studied, other correlates of CRP may include smoking status, plasma lipids (especially HDL cholesterol), hypertension, evidence of chronic infection, and measures of subclinical atherosclerotic disease, such as ankle-brachial blood pressure index (ABI).

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“…These tissues will release enzymes, primarily tPA (tissue plasminogen activator) activating the fibrinolytic system. 29 The fibrinolytic response is most pronounced intra operatively and early postoperatively. The half-life of TXA is 180 minutes which would cover the duration of surgery.…”

Section: Discussionmentioning

confidence: 99%

Effect of intravenous tranexamic acid on blood loss and blood transfusion in total knee replacement: a prospective, randomized study in Indian population

Kerakkanavar

Venkatesh

et al. 2017

Int J Res Orthop

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Background: Tranexamic acid (TXA) is antifibrinolytic drug which has the property to reduce intraoperative and postoperative bleeding. There are several studies supporting the use of tranexamic acid in total knee replacements (TKR) and few in total hip replacements. Our study was intended to establish the effects of tranexamic acid in minimizing the intra operative and post-operative blood loss in uncomplicated primary total knee replacement.Methods: This was a prospective follow up study conducted in Rajarajeshwari Medical College and Hospital Bangalore, over a period of 14 months from June 2015 to August 2016. A total number of 60 patients who underwent unilateral primary total knee replacement were included for this study. They were randomly divided into 2 groups. Group I patients infused (intravenous) with 20 mg/kg TXA before incision and 3 hours after surgery whereas no TXA was administered in Group II. Total blood loss and transfusion rate were used as outcome. Results: Mean amounts of blood loss were 578 ml in Group 1 and 946 ml in Group 2. There was a decrease in blood loss in TXA groups (p<0.001). Transfusion was required in 6 patients of Group I and 17 patients of Group II (p<0.001). No thromboembolic problem was seen in any patients.Conclusions: Since TXA decrease perioperative blood loss and lessen the need for blood transfusion significantly, without increasing thromboembolic events in TKR. We suggest using intravenous (IV) TXA in TKR.

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The postoperative fibrinolytic shutdown: a rapidly reverting acute phase pattern for the fast-acting inhibitor of tissue-type plasminogen activator after trauma

Cited by 310 publications

References 16 publications

Time course of thrombosis and fibrinolysis during total hip surgery

Time course of thrombosis and fibrinolysis during total hip surgery

Is Visceral Adiposity the “Enemy Within”?

Effect of intravenous tranexamic acid on blood loss and blood transfusion in total knee replacement: a prospective, randomized study in Indian population

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