Extrinsic and common coagulation pathway profiling in TJA patients
Authors: Wanderling Christopher , Liles Jeff , Finkler Elissa , Statz Stephen , Caarlsgard Peter , Hopkinson William , Hoppensteadt Debra , Fareed Jawed 
Published: November 2023

Methods

After IRB approval, blood samples were obtained from patients undergoing TJA as de‐identified samples day one pre‐ and day one post‐op. Blood samples were collected into tubes containing 3.2% sodium citrate, plasma was then isolated. Patient and control plasma samples were stored at −80°C. Plasma samples were analyzed on ELISA kits for fibrinogen, TAFI, TF, and MP‐TF (Hyphen Biomed, Neuville‐sur‐Oise, France) and fibrinogen activity was analyzed on the ACL300plus.

Results

In comparison with healthy controls, we saw significant increases of fibrinogen activity in the pre‐op (p=0.011) and the post‐op patients (p=0.0004). Comparing the pre‐ vs. post‐op patient populations, we saw no significant difference (p=0.273). Fibrinogen antigen levels, held a similar trend. However, while there was a significant difference between the normal subjects and pre‐op patients (p=0.002) and between the pre‐op and post‐op patients (p=0.008), there was no significant difference between the normal subjects and the post‐op patients (p=0.890). In comparison with the healthy controls, we saw significant increases of Thrombin Activatable Fibrinolysis Inhibitor (TAFI) in the pre‐op (p<0.0026) and the post‐op patients (p<0.0052). Comparing the pre‐op and post‐op patient populations, we saw no difference (p=0.742). In comparison with the healthy controls, we saw significant increases in TF pre‐op patients (p<0.0001) and the post‐op patients (p<0.0001). While comparing the pre‐op and post‐op patient populations, we did not see a significant difference (p=0.121).

Discussion

While coagulation studies of TJA patients have previously been performed, the aims of this study were to further investigate coagulation and inflammatory profiles of these individuals, particularly the involvement of the extrinsic and common coagulation pathways. Since TF, fibrinogen, and TAFI hold vital roles in coagulation and inflammation, the increased levels found in TJA patients may show their role in the pathogenesis of DJD and potential perioperative coagulopathies. The clinical significance of this study lies in the relevance of fibrinogen, TF, and TAFI in potential perioperative complications of TJA. With continued studies it may be possible to identify at‐risk patients, thus diminishing the incidence of perioperative complications along with diminishing the progression of DJD.

Support or Funding Information

This study was funded by internal funds through the Stritch School of Medicine STAR program

Control, preoperative, and post‐operative values and percent change for the measured thrombotic biomarkers, Tissue Factor (TF), Microparticles‐Tissue Factor (MP‐TF), fibrinogen activity and antigen, and Thrombin‐activatable fibrinolysis inhibitor (TAFI).

Control (C)
Pre‐op
Post‐op
Pre‐op vs. Post‐op

TF (pg/ml)
1096.0 ± 184.9
29.47 ± 38.6
22.4 ± 26.82
−19.07 ± 38.14

MP‐TF (pg/ml)
0.32 ± 0.20
0.48 ± 0.22
0.64 ± 0.57
47.79 ± 146.4

Fibrinogen antigen (mg/dl)
367.7 ± 52.18
424.0 ± 174.3
401.9 ± 187.6
−4.41 ± 30.42

Fibrinogen activity (mg/dl)
262.6 ± 27.37
345.7 ± 98.25
391.2 ± 147.7
21.87 ± 59.31

TAFI (%)
172.0 ± 22.59
135.7 ± 28.85
137.5 ± 28.44
3.11 ± 18.66