Tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty (TKA): a pilot study
Abstract Background Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce excessive bleeding and transfusion requirements. Our aim was to examine if TXA was required in all osteoarthritis patients undergoing TKA surgery, and its possible effects on systemic inflammation and coagulat...
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| Format: | Article |
| Language: | English |
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BMC
2018-06-01
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| Series: | Journal of Orthopaedic Surgery and Research |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13018-018-0855-5 |
| _version_ | 1818475031057924096 |
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| author | Andrea L. Grant Hayley L. Letson Jodie L. Morris Peter McEwen Kaushik Hazratwala Matthew Wilkinson Geoffrey P. Dobson |
| author_facet | Andrea L. Grant Hayley L. Letson Jodie L. Morris Peter McEwen Kaushik Hazratwala Matthew Wilkinson Geoffrey P. Dobson |
| author_sort | Andrea L. Grant |
| collection | DOAJ |
| description | Abstract Background Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce excessive bleeding and transfusion requirements. Our aim was to examine if TXA was required in all osteoarthritis patients undergoing TKA surgery, and its possible effects on systemic inflammation and coagulation properties. Methods Twenty-three patients (Oxford Score 22–29) were recruited consecutively; 12 patients received TXA before (IV, 1.2 g/90 kg) and immediately after surgery (intra-articular, 1.4 g/90 kg). Inflammatory mediators and ROTEM parameters were measured in blood at baseline, after the first bone-cut, immediately after surgery, and postoperative days 1 and 2. Results After the bone cut and surgery, TXA significantly increased MCP-1, TNF-α, IL-1β and IL-6 levels compared to non-TXA patients, which was further amplified postoperatively. During surgery, TXA significantly prolonged EXTEM clot times, indicating a thrombin-slowing effect, despite little or no change in clot amplitude or fibrinogen. TXA was associated with three- to fivefold increases in FIBTEM maximum lysis (ML), a finding counter to TXA’s antifibrinolytic effect. Maximum lysis for extrinsic and intrinsic pathways was < 8%, indicating little or no hyperfibrinolysis. No significant differences were found in postoperative hemoglobin between the two groups. Conclusions TXA was associated with increased systemic inflammation during surgery compared to non-TXA patients, with further amplification on postoperative days 1 and 2. On the basis of little or no change in viscoelastic clot strength, fibrinogen or clot lysis, there appeared to be no clinical justification for TXA in our group of patients. Larger prospective, randomized trials are required to investigate a possible proinflammatory effect in TKA patients. |
| first_indexed | 2024-04-14T04:45:09Z |
| format | Article |
| id | doaj.art-0b53137bb56d4ae8bcb0f13e783bce1b |
| institution | Directory Open Access Journal |
| issn | 1749-799X |
| language | English |
| last_indexed | 2024-04-14T04:45:09Z |
| publishDate | 2018-06-01 |
| publisher | BMC |
| record_format | Article |
| series | Journal of Orthopaedic Surgery and Research |
| spelling | doaj.art-0b53137bb56d4ae8bcb0f13e783bce1b2022-12-22T02:11:29ZengBMCJournal of Orthopaedic Surgery and Research1749-799X2018-06-0113111310.1186/s13018-018-0855-5Tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty (TKA): a pilot studyAndrea L. Grant0Hayley L. Letson1Jodie L. Morris2Peter McEwen3Kaushik Hazratwala4Matthew Wilkinson5Geoffrey P. Dobson6The Orthopaedic Research Institute of Queensland (ORIQL)Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook UniversityThe Orthopaedic Research Institute of Queensland (ORIQL)The Orthopaedic Research Institute of Queensland (ORIQL)The Orthopaedic Research Institute of Queensland (ORIQL)The Orthopaedic Research Institute of Queensland (ORIQL)Heart, Trauma and Sepsis Research Laboratory, College of Medicine and Dentistry, James Cook UniversityAbstract Background Tranexamic acid (TXA) is commonly used in orthopedic surgery to reduce excessive bleeding and transfusion requirements. Our aim was to examine if TXA was required in all osteoarthritis patients undergoing TKA surgery, and its possible effects on systemic inflammation and coagulation properties. Methods Twenty-three patients (Oxford Score 22–29) were recruited consecutively; 12 patients received TXA before (IV, 1.2 g/90 kg) and immediately after surgery (intra-articular, 1.4 g/90 kg). Inflammatory mediators and ROTEM parameters were measured in blood at baseline, after the first bone-cut, immediately after surgery, and postoperative days 1 and 2. Results After the bone cut and surgery, TXA significantly increased MCP-1, TNF-α, IL-1β and IL-6 levels compared to non-TXA patients, which was further amplified postoperatively. During surgery, TXA significantly prolonged EXTEM clot times, indicating a thrombin-slowing effect, despite little or no change in clot amplitude or fibrinogen. TXA was associated with three- to fivefold increases in FIBTEM maximum lysis (ML), a finding counter to TXA’s antifibrinolytic effect. Maximum lysis for extrinsic and intrinsic pathways was < 8%, indicating little or no hyperfibrinolysis. No significant differences were found in postoperative hemoglobin between the two groups. Conclusions TXA was associated with increased systemic inflammation during surgery compared to non-TXA patients, with further amplification on postoperative days 1 and 2. On the basis of little or no change in viscoelastic clot strength, fibrinogen or clot lysis, there appeared to be no clinical justification for TXA in our group of patients. Larger prospective, randomized trials are required to investigate a possible proinflammatory effect in TKA patients.http://link.springer.com/article/10.1186/s13018-018-0855-5Tranexamic acidTotal knee arthroplastyCoagulationInflammationOrthopaedic surgeryTrauma |
| spellingShingle | Andrea L. Grant Hayley L. Letson Jodie L. Morris Peter McEwen Kaushik Hazratwala Matthew Wilkinson Geoffrey P. Dobson Tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty (TKA): a pilot study Journal of Orthopaedic Surgery and Research Tranexamic acid Total knee arthroplasty Coagulation Inflammation Orthopaedic surgery Trauma |
| title | Tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty (TKA): a pilot study |
| title_full | Tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty (TKA): a pilot study |
| title_fullStr | Tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty (TKA): a pilot study |
| title_full_unstemmed | Tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty (TKA): a pilot study |
| title_short | Tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty (TKA): a pilot study |
| title_sort | tranexamic acid is associated with selective increase in inflammatory markers following total knee arthroplasty tka a pilot study |
| topic | Tranexamic acid Total knee arthroplasty Coagulation Inflammation Orthopaedic surgery Trauma |
| url | http://link.springer.com/article/10.1186/s13018-018-0855-5 |
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