Wanderling Christopher, Liles Jeffrey, Finkler Elissa, Carlsgaard Peter, Hopkinson William, Guler Nil, Hoppensteadt Debra, Fareed Jawed
1 Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA.
2 Department of Orthopedics, Loyola University Medical Center, Maywood, IL, USA.
Clin Appl Thromb Hemost. 2017 Nov;23(8):967-972. doi: 10.1177/1076029617700998. Epub 2017 Mar 27.
Total joint arthroplasty (TJA) of the hip or knee (THA, TKA) has become an increasingly common procedure. While TJA is a successful treatment for individuals experiencing degenerative joint diseases, it is well known that one of the most common perioperative complications of TJA is deep venous thrombosis (DVT). To profile tissue factor (TF), microparticle-tissue factor (MP-TF), thrombin-activatable fibrinolysis inhibitor (TAFI), and fibrinogen levels in patients undergoing TJA to determine potential preexisting Hemostatic dysregulation. De-identified blood samples were obtained from patients undergoing TJA 1 day pre- and 1 day postprocedure. Plasma samples were analyzed using enzyme-linked immunosorbent assay kits for fibrinogen, TAFI, TF, and MP-TF; fibrinogen levels were also assessed using a clot-based activity assay. In comparison with healthy controls, there were significant increases of fibrinogen and MP-TF levels, while there were significant decreases in TF and TAFI levels in the preoperative and postoperative patients. Comparing the pre versus postoperative patients, no significant differences were found; interestingly, however, surgical intervention exacerbated the changes found in the preoperative samples compared to the controls. The results of this study confirm that patients undergoing TJA have preexisting alterations in the fibrinolytic system. Surgical intervention tended to exacerbate these changes. The alterations observed in this study may provide insight as to why TJA is associated with higher rates of DVT and thromboembolism.
髋或膝关节的全关节置换术（TJA，包括全髋关节置换术[THA]和全膝关节置换术[TKA]）已成为越来越常见的手术。虽然TJA是治疗退行性关节疾病患者的一种成功方法，但众所周知，TJA最常见的围手术期并发症之一是深静脉血栓形成（DVT）。为了分析接受TJA患者的组织因子（TF）、微粒组织因子（MP-TF）、凝血酶激活的纤溶抑制物（TAFI）和纤维蛋白原水平，以确定潜在的既往存在的止血失调情况。从接受TJA的患者术前1天和术后1天获取去识别化的血样。使用酶联免疫吸附测定试剂盒分析血浆样本中的纤维蛋白原、TAFI、TF和MP-TF；纤维蛋白原水平也使用基于凝血的活性测定法进行评估。与健康对照相比，术前和术后患者的纤维蛋白原和MP-TF水平显著升高，而TF和TAFI水平显著降低。比较术前和术后患者，未发现显著差异；然而，有趣的是，与对照组相比，手术干预加剧了术前样本中发现的变化。本研究结果证实，接受TJA的患者存在纤溶系统的既往改变。手术干预往往会加剧这些变化。本研究中观察到的改变可能有助于解释为什么TJA与更高的DVT和血栓栓塞发生率相关。
