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. 2022 Nov 22;11(23):6897.
doi: 10.3390/jcm11236897.

Total Hip Arthroplasty Patients with Distinct Postoperative Fibrinolytic Phenotypes Require Different Antifibrinolytic Strategies

Jiacheng Liu  1 , Bowen Chen  1 , Xiangdong Wu  2 , Han Wang  3 , Xiaohai Zuo  1 , Yiting Lei  1 , Wei Huang  1
Affiliations

Total Hip Arthroplasty Patients with Distinct Postoperative Fibrinolytic Phenotypes Require Different Antifibrinolytic Strategies

Jiacheng Liu et al. J Clin Med. .

Abstract

Bleeding patients exhibit different fibrinolytic phenotypes after injury, and the universal use of tranexamic acid (TXA) is doubted. We aimed to evaluate the efficacy of postoperative antifibrinolytic treatment in total hip arthroplasty (THA) patients with different fibrinolytic phenotypes. A retrospective analysis was conducted in 238 patients who underwent THA. Patients were divided into two groups by different fibrinolytic phenotypes (non-fibrinolytic shutdown and fibrinolytic shutdown), determined by the LY30 level on postoperative day 1 (POD1). The two groups were further stratified into four sub-groups based on different postoperative TXA regimens (Group A received no TXA postoperatively, while Group B did). Hidden blood loss (HBL), decline of hemoglobin (ΔHb), D-dimer (D-D), fibrinogen/fibrin degradation product (FDP), prothrombin time (PT), activated partial thromboplastin time (APTT), and demographics were collected and compared. The clinical baseline data were comparable between the studied groups. In patients who presented non-fibrinolytic shutdown postoperatively, Group B suffered significantly lower HBL and ΔHb than Group A on POD3 and POD5. In patients who presented postoperative fibrinolytic shutdown, Group B failed to benefit from the postoperative administration of TXA when compared to Group A. No difference was found in postoperative levels of D-D, FDP, PT, and APTT. Postoperative antifibrinolytic therapy is beneficial for THA patients who presented non-fibrinolytic shutdown postoperatively, while the efficacy and necessity should be considered with caution in those with fibrinolytic shutdown. LY30 is a promising parameter to distinguish different fibrinolytic phenotypes and guide TXA administration. However, further prospective studies are needed to confirm these findings.

Keywords: antifibrinolysis; blood loss; fibrinolytic phenotype; fibrinolytic shutdown; total hip arthroplasty; tranexamic acid.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
The flow chart of study enrolment. Hb, hemoglobin; post-OP, postoperative; TXA, tranexamic acid.
Figure 2
Figure 2
Dynamic changes of postoperative hidden blood loss and decline of hemoglobin levels. (A) In patients who presented non-fibrinolytic shutdown, postoperative hidden blood loss between Groups A and B. (B) In patients who presented non-fibrinolytic shutdown, decline of hemoglobin levels between Groups A and B. (C) In patients who presented fibrinolytic shutdown, postoperative hidden blood loss between Groups A and B. (D) In patients who presented fibrinolytic shutdown, decline of hemoglobin levels between Groups A and B. HBL, hidden blood loss; POD, postoperative day; ΔHb, decline of hemoglobin levels; *, p < 0.05.
See this image and copyright information in PMC

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