Variable Response to Antifibrinolytics Correlates with Blood-loss and Transfusion in Posterior Spinal Fusion.

Autor: Gibson BHY; Department of Pharmacology, Vanderbilt University, Nashville, TN, USA., Duvernay MT; Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA., McKeithan LJ; Vanderbilt University School of Medicine, Nashville, TN, USA., Benvenuti TA; Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA., Warhoover TA; Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA., Martus JE; Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA.; Department of Pediatrics, Vanderbilt University Medical Center, 1155 MRBIV, 2215B Garland Ave, Nashville, TN, 37232, USA., Mencio GA; Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA.; Department of Pediatrics, Vanderbilt University Medical Center, 1155 MRBIV, 2215B Garland Ave, Nashville, TN, 37232, USA., Emerson BR; Department of Pediatric Anesthesiology, Vanderbilt University Medical Center, Nashville, TN, USA., Moore-Lotridge SN; Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA.; Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA., Borst AJ; Department of Pediatrics, Vanderbilt University Medical Center, 1155 MRBIV, 2215B Garland Ave, Nashville, TN, 37232, USA.; Department of Hematology and Oncology, Vanderbilt University Medical Center, Nashville, TN, USA., Schoenecker JG; Department of Pharmacology, Vanderbilt University, Nashville, TN, USA. jon.schoenecker@vumc.org.; Department of Orthopaedics, Vanderbilt University Medical Center, Nashville, TN, USA. jon.schoenecker@vumc.org.; Department of Pediatrics, Vanderbilt University Medical Center, 1155 MRBIV, 2215B Garland Ave, Nashville, TN, 37232, USA. jon.schoenecker@vumc.org.; Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA. jon.schoenecker@vumc.org.; Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA. jon.schoenecker@vumc.org.; Vanderbilt Center for Bone Biology, Vanderbilt University Medical Center, Nashville, TN, USA. jon.schoenecker@vumc.org.
Jazyk: angličtina
Zdroj: Spine deformity [Spine Deform] 2022 Jul; Vol. 10 (4), pp. 841-851. Date of Electronic Publication: 2022 Mar 05.
DOI: 10.1007/s43390-022-00489-6
Abstrakt: Purpose: Posterior spinal fusion (PSF) activates the fibrinolytic protease plasmin, which is implicated in blood loss and transfusion. While antifibrinolytic drugs have improved blood loss and reduced transfusion, variable blood loss has been observed in similar PSF procedures treated with the same dose of antifibrinolytics. However, both the cause of this and the appropriate measures to determine antifibrinolytic efficacy during high-blood-loss spine surgery are unknown, making clinical trials to optimize antifibrinolytic dosing in PSF difficult. We hypothesized that patients undergoing PSF respond differently to antifibrinolytic dosing, resulting in variable blood loss, and that specific diagnostic markers of plasmin activity will accurately measure the efficacy of antifibrinolytics in PSF.
Methods: A prospective study of 17 patients undergoing elective PSF with the same dosing regimen of TXA was conducted. Surgery-induced plasmin activity was exhaustively analyzed in perioperative blood samples and correlated to measures of inflammation, bleeding, and transfusion.
Results: While markers of in vivo plasmin activation (PAP and D-dimer) suggested significant breakthrough plasmin activation and fibrinolysis (P < 0.01), in vitro plasmin assays, including TEG, did not detect plasmin activation. In vivo measures of breakthrough plasmin activation correlated with blood loss (R 2  = 0.400, 0.264; P < 0.01), transfusions (R 2  = 0.388; P < 0.01), and complement activation (R 2  = 0.346, P < 0.05).
Conclusions: Despite all patients receiving a high dose of TXA, its efficacy among patients was variable, indicated by notable intra-operative plasmin activity. Markers of in vivo plasmin activation best correlated with clinical outcomes. These findings suggest that the efficacy of antifibrinolytic therapy to inhibit plasmin in PSF surgery should be determined by markers of in vivo plasmin activation in future studies.
Level of Evidence: Level II-diagnostic.
(© 2022. The Author(s), under exclusive licence to Scoliosis Research Society.)
Databáze: MEDLINE
Externí odkaz: