title: Fibrinolytic Dysregulation in Total Joint Arthroplasty Patients: Potential Clinical Implications.
abstract: BACKGROUND
  The alterations of the fibrinolytic components in osteoarthritic joint disease and their postsurgical modulation are not clearly understood. Preexisting hemostatic dysfunction may lead to both thrombotic and bleeding events in these patients.
  
  
  OBJECTIVE
  To profile fibrinolytic parameters in patients undergoing total joint arthroplasty prior to and on postoperative day 1.
  
  
  METHODS
  A total of 98 total joint arthroplasty patients were included in this study. Blood samples were drawn preoperatively and on postoperative day 1 status posttotal knee or total hip arthroplasty surgery. d-Dimer, plasminogen activator inhibitor 1 (PAI-1), and tissue plasminogen activator (tPA) were measured using commercially available enzyme-linked immunosorbent assay kits. Antiplasmin activity was measured by using a functional method.
  
  
  RESULTS
  Preoperative PAI-1, d-dimer, and tPA levels were significantly higher in arthroplasty patients compared to healthy controls. Preoperative antiplasmin level was lower than controls. Postoperative levels of PAI-1 and d-dimer were increased compared to preoperative values. Postoperative antiplasmin values were lower than preoperative levels. Changes in tPA was not significant. There was no correlation between preoperative PAI-1 and d-dimer levels. Pre- and postoperative percentage changes in each individual were calculated for PAI-1, d-dimer, tPA, and antiplasmin. There was a positive correlation between d-dimer and PAI-1. Negative correlations between antiplasmin and d-dimer and between antiplasmin and PAI-1 were noted.
  
  
  CONCLUSIONS
  These results confirm the perturbation in the fibrinolytic system of patients undergoing total joint arthroplasty surgery. Surgical intervention may also enhance the observed changes. The alterations in the fibrinolytic system may lead to the observed hemostatic complications such as bleeding, hematoma formation, or potential need for blood transfusion.
authors.affiliation: Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA nilvecay@yahoo.com.
authors.forename: Nil
authors.initials: N
authors.lastname: Guler
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Burleson
authors.affiliation: Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Daneyal
authors.initials: D
authors.lastname: Syed
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Andrew
authors.initials: A
authors.lastname: Banos
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: William
authors.initials: W
authors.lastname: Hopkinson
authors.affiliation: Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Debra
authors.initials: D
authors.lastname: Hoppensteadt
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Harold
authors.initials: H
authors.lastname: Rees
authors.affiliation: Department of Pathology and Pharmacology, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: Jawed
authors.initials: J
authors.lastname: Fareed
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood; D019106:Postoperative Hemorrhage / Q000097:blood*; D011184:Postoperative Period; D057234:Preoperative Period; D010959:Tissue Plasminogen Activator / Q000097:blood; D000979:alpha-2-Antiplasmin / Q000378:metabolism
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; D000979:alpha-2-Antiplasmin; C036309:fibrin fragment D; D010959:Tissue Plasminogen Activator
keywords: PAI-1; antiplasmin; arthroplasty; d-dimer; fibrinolytic system; tPA