Durata della fibrinolisi post-operatoria e rischio trombotico dopo somministrazione di acido tranexamico negli interventi di protesi d’anca e ginocchio

Duration of post-operative fibrinolysis and thrombotic risk after tranexamic acid administration in hip and knee prosthesis interventions. Strong evidence indicates that TXA reduces blood loss and blood transfusion requirement in orthopedic surgery. However, drug safety and side effects are still a controversial issue, because TXA may increase thromboembolic risk. Aim of our study was to quantify the duration of postoperative fibrinolysis and to assess the impact of TXA administration after total hip (THR) and total knee replacement (TKR). Fifteen patients undergoing THR and 10 undergoing TKR were included in the study. Among these patients, 14 THR and 8 TKR received TXA, while 3 (one THR and 2 TKR) were employed as controls (i.e., no TXA administration). D-dimer and thrombin generation time were measured prior to surgery as well as 3, 6, 24 and 72 h after. No statistically significant difference in D-dimer was observed between patients treated and not treated with TXA, even if D-dimer increased postoperatively (6 h) more in patients not treated with TXA than in patients receiving TXA. Thrombin peak was lower in patients treated with TXA than in patients not receiving it. Our study shown that TXA limits postoperative fibrinolysis after THR and TKR, as evidenced by a lesser increase in D-dimer in patients receiving TXA, with no increase in prothrombotic risk.