CHANGES IN CIRCULATORY INDEXES OF THROMBOSIS AND FIBRINOLYSIS DURING TOTAL KNEE ARTHROPLASTY PERFORMED UNDER TOURNIQUET

Deep vein thrombosis may begin during surgery with the tourniquet infl ated. Arterial levels of fibrinopeptide A, thrombin-antithrombin compl exes, D-dimer, tissue plasminogen activator (t-PA) activity, and t-PA antigen were measured before surgery, during surgery with the tourniqu et inflated, and following deflation of the tourniquet in 12 patients undergoing total knee arthroplasty. Minimal increases in fibrinopeptid e A, thrombin-antithrombin complexes, and D-dimer were noted during su rgery with the tourniquet inflated, but significant increases occurred immediately following deflation of the tourniquet. In 10 patients, in travenous heparin,administration significantly suppressed the rise in fibrinopeptide A, but did not significantly alter the increases in eit her thrombin-antithrombin complexes, D-dimer, t-PA antigen, or t-PA ac tivity. This study provides further evidence that deep vein thrombosis begins during surgery.