title: Perioperative Factors and Their Effect on the Fibrinolytic System in Arthroplasty Patients.
abstract: BACKGROUND
  Total joint arthroplasty (TJA) patients are mostly of advanced age and with comorbidities such as increased body mass index (BMI) and impaired glucose tolerance. These factors and type of surgery may affect the fibrinolytic system.
  
  
  OBJECTIVE
  To investigate the effect of age, sex, BMI, type of surgery, and tranexamic acid (TXA) treatment on the fibrinolytic system in TJA patients.
  
  
  METHODS
  Ninety-nine patients undergoing TJA (32 total hip arthroplasty [THA] and 67 total knee arthroplasty [TKA]) were included in this study. Blood samples were drawn at preoperative clinic appointments and on postoperative day 1. Antigenic levels of d-dimer, plasminogen activator inhibitor 1 (PAI-1), and tissue plasminogen activator (tPA) were measured using a commercially available enzyme-linked immunosorbent assay kit. Antiplasmin activity was measured using functional method. Age, gender, hemoglobin (Hb) levels, and BMI were collected from the records.
  
  
  RESULTS
  Preoperative d-dimer and tPA levels were positively correlated with age, whereas preoperative antiplasmin was negatively correlated with age. Body mass index was only associated with preoperative tPA levels. There was no significant difference in postoperative levels of d-dimer, PAI-1, tPA, or antiplasmin between patients treated with TXA or without TXA. Percentage change in d-dimer and tPA showed significantly lower values in patients treated with TXA compared to the nontreated group. Type of surgery did not affect the fibrinolytic markers.
  
  
  CONCLUSIONS
  These results confirm that advanced age and elevated BMI positively contribute to fibrinolytic dysregulation in TJA patients, whereas TXA seems to decrease the fibrinolytic activity.
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 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: Banos
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: Stritch School of Medicine, Loyola University of Chicago, Maywood, IL, USA.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wanderling
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
authors.affiliation: Department of Orthopaedic Surgery and Rehabilitation, Loyola University Medical Center, Maywood, IL, USA.
authors.forename: William
authors.initials: W
authors.lastname: Hopkinson
mesh_terms: D000367:Age Factors; D000368:Aged; D019644:Arthroplasty, Replacement, Hip; D019645:Arthroplasty, Replacement, Knee; D015992:Body Mass Index; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005342:Fibrinolysis; D006801:Humans; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D017395:Plasminogen Activator Inhibitor 1 / Q000097:blood*; D012737:Sex Factors; D010959:Tissue Plasminogen Activator / Q000097:blood*
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D017395:Plasminogen Activator Inhibitor 1; C051321:SERPINE1 protein, human; C036309:fibrin fragment D; D010959:Tissue Plasminogen Activator
keywords: BMI; THA; TKA; age; bleeding; hemostasis; hypercoagulability; tranexamic