Total Hip Arthroplasty Patients with Distinct Postoperative Fibrinolytic Phenotypes Require Different Antifibrinolytic Strategies

作者全名："Liu, Jiacheng; Chen, Bowen; Wu, Xiangdong; Wang, Han; Zuo, Xiaohai; Lei, Yiting; Huang, Wei"

作者地址："[Liu, Jiacheng; Chen, Bowen; Zuo, Xiaohai; Lei, Yiting; Huang, Wei] Chongqing Med Univ 1, Orthoped Lab Chongqing Med Univ, Affiliated Hosp 1, Dept Orthoped, Chongqing 400016, Peoples R China; [Wu, Xiangdong] Chinese Acad Med Sci & Peking Union Med Coll, Peking Union Med Coll Hosp, Dept Orthoped Surg, Beijing 100730, Peoples R China; [Wang, Han] Fujian Med Univ, Zhangzhou Affiliated Hosp, Dept Orthoped, Zhangzhou 363000, Peoples R China"

通信作者："Lei, YT; Huang, W (通讯作者)，Chongqing Med Univ 1, Orthoped Lab Chongqing Med Univ, Affiliated Hosp 1, Dept Orthoped, Chongqing 400016, Peoples R China."

来源：JOURNAL OF CLINICAL MEDICINE

ESI学科分类：CLINICAL MEDICINE

WOS号：WOS:000896608700001

JCR分区：Q2

影响因子：3.9

年份：2022

卷号：11

期号：23

开始页：　

结束页：　

文献类型：Article

关键词：total hip arthroplasty; fibrinolytic phenotype; fibrinolytic shutdown; antifibrinolysis; tranexamic acid; blood loss

摘要："Bleeding patients exhibit different fibrinolytic phenotypes after injury, and the universal use of tranexamic acid (TXA) is doubted. We aimed to evaluate the efficacy of postoperative antifibrinolytic treatment in total hip arthroplasty (THA) patients with different fibrinolytic phenotypes. A retrospective analysis was conducted in 238 patients who underwent THA. Patients were divided into two groups by different fibrinolytic phenotypes (non-fibrinolytic shutdown and fibrinolytic shutdown), determined by the LY30 level on postoperative day 1 (POD1). The two groups were further stratified into four sub-groups based on different postoperative TXA regimens (Group A received no TXA postoperatively, while Group B did). Hidden blood loss (HBL), decline of hemoglobin (Delta Hb), D-dimer (D-D), fibrinogen/fibrin degradation product (FDP), prothrombin time (PT), activated partial thromboplastin time (APTT), and demographics were collected and compared. The clinical baseline data were comparable between the studied groups. In patients who presented non-fibrinolytic shutdown postoperatively, Group B suffered significantly lower HBL and Delta Hb than Group A on POD3 and POD5. In patients who presented postoperative fibrinolytic shutdown, Group B failed to benefit from the postoperative administration of TXA when compared to Group A. No difference was found in postoperative levels of D-D, FDP, PT, and APTT. Postoperative antifibrinolytic therapy is beneficial for THA patients who presented non-fibrinolytic shutdown postoperatively, while the efficacy and necessity should be considered with caution in those with fibrinolytic shutdown. LY30 is a promising parameter to distinguish different fibrinolytic phenotypes and guide TXA administration. However, further prospective studies are needed to confirm these findings."

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