Changes in Blood Coagulation–Fibrinolysis Markers By Pneumatic Tourniquet During Total Knee Joint Arthroplasty With Venous Thromboembolism

This study investigated changes in blood coagulation–fibrinolysis markers during total knee arthroplasty (TKA). Preoperative 16-row multidetector row computed tomography (MDCT) revealed no asymptomatic venous thromboembolism (VTE) in the 42 patients recruited. Using MDCT postoperatively, patients were divided into thrombus (asymptomatic VTE, 19 patients) and no-thrombus (23 patients) groups. Blood taken at intervals before and after pneumatic tourniquet release revealed increased plasminogen activator inhibitor type-1 (PAI-1) at 30 s for both groups and at 90 s (both P = 0.01) in the thrombus group. d-dimer levels were highest at 30 and 90 s for both groups (P = 0.01). PAI-1 and d-dimer levels were strongly correlated at both time points in the thrombus group. Inactivating fibrinolysis due to PAI-1 may lead to asymptomatic VTE after TKA.