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Thigh-tourniquet application during knee arthroscopy does not induce a hypercoagulable state – A randomized trial into the effect of tourniquet use on the coagulation system.

1Department of Clinical Epidemiology and Department of Orthopedics, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands, 2Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands, 3Department of Clinical Epidemiology and Department of Medical Statistics and Bioinformatics, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands, 4Department of Orthopaedic Surgery, Groene Hart Hospital, Gouda, Zuid-Holland, Netherlands, 5Department of orthopaedics, Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands, 6Department of orthopaedics Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands, 7University Medical Center Groningen, Groningen, The Netherlands, Groningen, Not Applicable, Netherlands, 8Leiden University Medical Center, Leiden, Zuid-Holland, Netherlands

Abstract Number: PB0558

Meeting: ISTH 2022 Congress

Theme: Coagulation and Natural Anticoagulants » Coagulation Factors and Inhibitors

Background: Knee arthroscopy is associated with an increased risk of venous thromboembolism (VTE), in which the role of thigh-tourniquet application is unknown.

Aims: To study the effect of a thigh-tourniquet application on coagulation, fibrinolysis, endothelial activation, inflammation and hypoxia.

Methods: A single center, non-blinded, randomized controlled trial was conducted. Patients >18years scheduled for knee arthroscopy were randomized to tourniquet or no tourniquet application. Most important exclusion criteria were: any coagulation disorder, pregnancy, hormonal contraceptive use or a history of VTE. Blood was drawn from the cubital vein preoperatively (T0), at the end of surgery (T1) and one hour after surgery (T2). At T1 and T2, blood was also drawn from the great saphenous vein of the operated leg (Figure1). Lactate, white blood cell count (WBCC), von Willebrand Factor (VWF) antigen, E-Selectin, thrombomodulin, factor (F)VIII activity, D-dimer, thrombin generation potential and clot lysis time were measured. For each person, mean changes between T0 and T1 or T2 were obtained by a paired t-tests. Differences in change between groups were obtained by linear mixed models.

Results: 286 patients were assessed for inclusion, 28 and 27 patients were randomized to tourniquet (Group I) and no tourniquet (Group II) application, respectively. Systemic and local measurements yielded similar results; therefore, only systemic results are shown. Postoperative changes of hypoxia (lactate) and inflammation (WBCC) markers did not differ between groups. This was also true for most markers of endothelial activation, coagulation and fibrinolysis. Only VWF and FVIII levels were different between groups. Whereas FVIII and VWF levels declined at T2 in the tourniquet group, these levels increased in the no-tourniquet group resulting in a significant difference between groups (Table1).

Conclusion(s): Tourniquet application during knee arthroscopy did not affect coagulation, fibrinolysis, endothelial activation, inflammation or hypoxia and therefore does not appear to explain the increased VTE risk.

ClinicalTrials.gov:NCT02567903

Funding: Foundation Anna Fonds|NOREF

image

Figure 1. Schematic overview of study intervention

Table

Table1: Plasma levels of coagulation, fibrinolysis, endothelial activation, inflammation and hypoxia measured in the arm -systemic- at T0, T1 and T2 compared between tourniquet and no tourniquet groups

To cite this abstract in AMA style:

Nemeth B, Touw C, le Cessie S, Onstenk R, Wennemers V, Haen P, van den Wijngaard R, van Adrichem R, Nelissen R, Lisman T, Cannegieter S. Thigh-tourniquet application during knee arthroscopy does not induce a hypercoagulable state – A randomized trial into the effect of tourniquet use on the coagulation system. [abstract]. https://abstracts.isth.org/abstract/thigh-tourniquet-application-during-knee-arthroscopy-does-not-induce-a-hypercoagulable-state-a-randomized-trial-into-the-effect-of-tourniquet-use-on-the-coagulation-system/. Accessed October 1, 2023.

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