Time course of XXXX and fibrinolysis in total knee arthroplasty with tourniquet application. Local versus systemic activations.

@entity1 @entity2994 @entity49 @entity2786 @entity715
BACKGROUND: @entity49 is common in knee surgery, and it has been assumed that @entity2994 by tourniquet in itself may induce thrombogenic and fibrinolytic activity. Prophylactic treatment is used up to 12 h before or after surgery, and recent clinical trials suggest that the timing of initiating prophylaxis significantly influences antithrombotic effectiveness. MATERIALS AND METHODS: We studied the time course of coagulation and fibrinolysis locally and systemically during total knee arthroplasty. Specific markers of @entity715 (prothrombin fragment 1.2 (F1.2)) and fibrinolysis (plasmin-antiplasmin ( @entity2786 ) and D-dimer) were examined in seven female and two male @entity1 . RESULTS: There were no systemic activations of either F1.2 (P = 0.314), @entity2786 (P = 0.314) or D-dimer (P = 0.600) during surgery or at 10 min postoperatively (P = 0.139, 0.139 and 0.128, respectively) as compared to baseline data. At 4 h postoperatively there were significant increments in levels of F1.2 (P = 0.008), @entity2786 (P = 0.038) and D-dimer (P = 0.046). With tourniquet deflation the values of F1.2, @entity2786 and D-dimer were significantly higher in the tourniquet limb than the in the contra lateral limb (P = 0.025, 0.012 and 0.028, respectively). At 10 min after tourniquet deflation, the differences in F1.2, @entity2786 and D-dimer between the two limbs were not significant. CONCLUSION: The use of tourniquet in total knee arthroplasty causes local thrombogenic and fibrinolytic activity, but without influences in the systemic circulation. Systemic activations in @entity715 and fibrinolysis start when local mediators from the injured limb are released after tourniquet deflation.
