title: Effects of steroids on thrombogenic markers in patients undergoing unilateral total knee arthroplasty: a prospective, double-blind, randomized controlled trial.
abstract: Venous thromboembolism (VTE) remains an important complication after total knee arthroplasty (TKA). Systemic thrombin generation starts perioperatively. Inflammation, characterized by a rise in interleukin-6 (IL6), initiates the coagulation cascade, but low-dose steroids can reduce post-TKA IL6 levels. This double-blinded, randomized, placebo-controlled study enrolled 30 patients undergoing unilateral TKA to assess the effect of perioperative steroids on serum prothrombin fragment (PF1.2), a marker of thrombin generation, and plasmin-alpha-2-antiplasmin complex (PAP), a marker of fibrinolysis. Study patients received 100 mg of intravenous hydrocortisone 2 h prior to surgery, and controls received normal saline. Blood samples, drawn pre-incision and at 4 h post tourniquet release, were assayed for PF1.2 and PAP. The study group had significantly lower mean PF1.2 at 4 h compared to controls (616 ± 358 pMol/L vs. 936 ± 332 pMol/L, p = 0.037). The mean rise in PF1.2 in the control group was significantly greater compared to the study group (672 ± 173 pMol/L vs. 350 ± 211 pMol/L, p < 0.001). Mean PAP was higher in the study group at 4 h (1639 ± 823 µg/L vs. 1087 ± 536 µg/L), but did not reach statistical significance (p = 0.07). These results may have clinical implications in terms of postoperative VTE risk and management.
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th Street, NY, 10021, New York.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: McLawhorn
authors.forename: Jonathan
authors.initials: J
authors.lastname: Beathe
authors.forename: Jacques
authors.initials: J
authors.lastname: YaDeau
authors.forename: Valeria
authors.initials: V
authors.lastname: Buschiazzo
authors.forename: P Edward
authors.initials: PE
authors.lastname: Purdue
authors.forename: Yan
authors.initials: Y
authors.lastname: Ma
authors.forename: Thomas P
authors.initials: TP
authors.lastname: Sculco
authors.forename: Kethy
authors.initials: K
authors.lastname: Jules-Elysée
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D004311:Double-Blind Method; D005260:Female; D005341:Fibrinolysin / Q000032:analysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D010446:Peptide Fragments / Q000097:blood; D011183:Postoperative Complications / Q000517:prevention & control*; D011446:Prospective Studies; D011516:Prothrombin; D013917:Thrombin / Q000096:biosynthesis; D054556:Venous Thromboembolism / Q000517:prevention & control*; D000979:alpha-2-Antiplasmin / Q000032:analysis
chemical_list: D000305:Adrenal Cortex Hormones; D010446:Peptide Fragments; D000979:alpha-2-Antiplasmin; C037742:plasmin-plasmin inhibitor complex; C045879:prothrombin fragment 1.2; D011516:Prothrombin; D013917:Thrombin; D005341:Fibrinolysin
keywords: blood coagulation; hydrocortisone; inflammation mediators; knee arthroplasty; venous thromboembolism