The Immunomodulatory Effect of Antrifibrinolytic (Tranexamic Acid) in Total Knee Arthroplasty
Status:
Unknown status
Trial end date:
2019-12-01
Target enrollment:
Participant gender:
Summary
The administration of the tranexamic acid (TRAXA), an antifibrinolytic, blocks primary
fibrinolysis, and thus the haemorrhage, in the early postoperative period. Significant
surgical operations, as well as trauma, initiate a similar dynamic homeostatic mechanism
between the creation of a clot (primary and secondary haemostasis) and its dissolution
(fibrinolysis). Antifibrinolytics have been proven effective in reducing haemorrhage in
patients who have undergone significant surgical operations with normal fibrinolysis, with
the use of an appropriate surgical technique.
A pharmacokinetic study has shown that peak fibrinolytic activity is present for 6 hours
after the incision and it persists for 18 hours in total knee and hip arthroplasty. The
administration of the tranexamic acid in optional orthopaedic surgery of total hip (THA) and
knee (TKA) arthroplasty reduces the postoperative haemorrhage, as well as the number and
volume of the postoperative autologous blood.
A trauma in the organism triggers the immunologic response. New term has been introduced -
the post-traumatic immunosuppression (PTI), characterised by: a change on the immunologic
cells (neutrophilia, monocytosis, increased number of mesenchymal stromal cells, reduced
expression of HLA-DR on monocytes, reduced function of natural killer (NK) cells, increased
lymphocyte apoptosis, a shift in homoeostasis towards the Th2 phenotype facilitated by Treg
lymphocytes - CD4+CD25+CD127-); a change in production levels of various cytokines
(anti-inflammatory cytokines): IL-10, IL-4; anti- and pro-inflammatory cytokine: IL-6;
pro-inflammatory cytokines IL-2, TNF-α, IFN-γ); the activation of the complement system (C5a
and C3a via factor VII - tissue factor system, activated by cell damage).
Post-traumatic immunosuppression can be made worse by transfusion, haemorrhage, stress,
significant surgical operation and immunosuppressive drugs.
The research has shown that Treg lymphocytes CD4+CD25+CD127- have an important role in
controlling the acquired and innate immunity (comprising 6-8% of all CD4+ lymphocytes).
Stopping haemorrhage prevents the occurrence of anaemia, as well as the need for transfusion
of blood products, which lead to developing the post-traumatic immunosuppression (PTI).