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Clinical Trial
. 2017 Nov;23(8):967-972.
doi: 10.1177/1076029617700998. Epub 2017 Mar 27.

Dysregulation of Tissue Factor, Thrombin-Activatable Fibrinolysis Inhibitor, and Fibrinogen in Patients Undergoing Total Joint Arthroplasty

Christopher Wanderling  1 , Jeffrey Liles  1 , Elissa Finkler  2 , Peter Carlsgaard  1 , William Hopkinson  2 , Nil Guler  3 , Debra Hoppensteadt  3 , Jawed Fareed  3
Affiliations
Clinical Trial

Dysregulation of Tissue Factor, Thrombin-Activatable Fibrinolysis Inhibitor, and Fibrinogen in Patients Undergoing Total Joint Arthroplasty

Christopher Wanderling et al. Clin Appl Thromb Hemost. 2017 Nov.

Abstract

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.

Keywords: arthroplasty; coagulation; fibrinolysis; inflammation.

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Conflict of interest statement

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Box plot showing median levels of tissue factor (TF) measured in control, preoperative, and postoperative groups. Boxes show interquartile ranges and I bars demonstrate highest and lowest values.
Figure 2.
Figure 2.
Box plot showing median levels of microparticles-tissue factor (MP-TF) measured in control, preoperative, and postoperative groups. Boxes show interquartile ranges and I bars demonstrate highest and lowest values.
Figure 3.
Figure 3.
Box plot showing median levels of thrombin-activatable fibrinolysis inhibitor (TAFI) measured in control, preoperative, and postoperative groups. Boxes show interquartile ranges and 1 bars demonstrate highest and lowest values.
Figure 4.
Figure 4.
Box plot showing median levels of fibrinogen antigen (gray) and activity (white) measured in control, preoperative, and post-operative groups. Boxes show interquartile ranges and I bars demonstrate highest and lowest values.
Figure 5.
Figure 5.
Scatter plot demonstrating the positive correlation as measured by the Spearman correlation coefficient (r = .346, P = .0237).
See this image and copyright information in PMC

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