PB0558 - 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.

Monday, July 11, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: In-Person

Presenting Author(s)

Banne Nemeth, MD, PhD

Postdoc
Department of Clinical Epidemiology and Department of Orthopedics, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands

Co-Author(s)

CT

Carolina E. Touw

PhD student
Department of Clinical Epidemiology, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
Sl

Saskia le Cessie

professor
Department of Clinical Epidemiology – LUMC – Netherlands and Department of biomedical data sciences – LUMC - Netherlands
Leiden, Zuid-Holland, Netherlands
RO

Ron Onstenk

MD
Department of Orthopaedic Surgery, Groene Hart Hospital
Gouda, Zuid-Holland, Netherlands
VW

Vincent Wennemers

MD
Department of Orthopaedic Surgery, Groene Hart Hospital
Gouda, Zuid-Holland, Netherlands
PH

Pieter Stijn Haen

MD
Department of Orthopaedic Surgery, Groene Hart Hospital
Gouda, Zuid-Holland, Netherlands
Rv

Rene van den Wijngaard

MD
Department of Orthopaedic Surgery, Groene Hart Hospital
Gouda, Zuid-Holland, Netherlands
Rv

Raymond van Adrichem

MD PHD
Department of orthopaedics, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
RN

Rob G.H.H. Nelissen

Professor
Department of Orthopedics, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands
Ton Lisman, PhD

Professor of Experimental Surgery
UMCG
Groningen, Groningen, Netherlands
SC

Suzanne C. Cannegieter, MD PhD

Professor
Department of Clinical Epidemiology, Leiden University Medical Center
Leiden, Zuid-Holland, Netherlands

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