PubMed · 9038728
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B J Hunt, H Segal. 1996. Hyperfibrinolysis.. https://doi.org/10.1136/jcp.49.12.958
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Blood loss in total knee arthroplasty is some-times profuse and often necessitates transfusion which is associated with a risk of disease transmission and immunological burden to the recipient. The fibrinolytic system is activated during surgery, an activation augmented by the tourniquet often used in knee arthroplasty. We have found tranexamic acid, a well-known fibrinolytic inhibitor, to reduce blood loss by half in total knee arthroplasty, and the need of transfusion by two thirds. For optimal efficacy, the tranexamic acid should be administered as prophylaxis before release of the tourniquet. We have found no adverse effects of the drug.
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We retrospectively measured various hemostatic markers in 240 patients with disseminated intravascular coagulation (DIC) before the onset of DIC and in 110 non-DIC patients, and examined their usefulness for the diagnosis of pre-DIC. Changes in prothrombin time ratio and fibrinogen levels were not significant before the onset of DIC. The plasma levels of fibrinogen and fibrin degradation products before the onset of DIC were increased and the platelet count was gradually reduced in nonleukemic patients; these changes were already significant in the non-DIC state. The plasma levels of thrombin-antithrombin complex (TAT), plasmin-plasmin inhibitor complex (PPIC), D-dimer, and soluble fibrin monomer (sFM) were increased before the onset of DIC. In leukemic patients, the plasma levels of sFM on day 5, those of TAT on day 3, and D-dimer on day 1, were significantly increased before the onset of DIC. The levels of most hemostatic markers 7 days before the onset of DIC were not different from those observed in the non-DIC state. In nonleukemic patients, only D-dimer, sFM, and TAT levels were significantly increased 7 days before the onset of DIC compared with values in the non-DIC state. The positive rate of hemostatic markers for the diagnosis of DIC, TAT, and PPIC were high during the pre-DIC and non-DIC groups. The plasma levels of sFM and D-dimer were low in non-DIC and increased gradually during the pre-DIC state. These findings suggest that hemostatic molecular markers such as sFM, D-dimer, and TAT are useful for the diagnosis of pre-DIC, although their cutoff values were different among various diseases.