Revolutionizing Antifibrinolytic Therapy: Personalized Strategies for Total Hip Arthroplasty Patients Who Have Divergent Fibrinolytic Responses.

Abstract

While empirical antifibrinolysis immediately postsurgery effectively reduces postoperative hidden blood loss (HBL), the emerging concept of fibrinolytic phenotypes may challenge this routine practice. This randomized controlled trial investigated the efficacy of using the fibrinolytic marker LY30 to distinguish divergent phenotypes following total hip arthroplasty (THA), thereby enabling personalized antifibrinolysis strategies. There were 204 patients undergoing THA for end-stage hip diseases prospectively recruited and randomly assigned to control and antifibrinolysis groups. Based on the LY30 levels on postoperative day one (POD one), patients were further classified into four subgroups: fibrinolytic shutdown (FSD) and nonfibrinolytic shutdown (NFSD). Primary outcomes assessed were HBL and hemoglobin drop (ΔHb). Key coagulation metrics, incidence of venous thromboembolism, and additional complications were also recorded and compared. There were two rounds of statistical analyses conducted based on different interventions and fibrinolytic phenotypes, respectively. The first intervention-specific analysis revealed that in the control group, NFSD patients suffered significantly higher HBL and ΔHb on POD3 compared to FSD patients, with no differences observed on POD1. However, in the antifibrinolysis group, the HBL and ΔHb levels remained consistent between NFSD and FSD patients. The second phenotype-based analysis indicated that the antifibrinolytic therapy significantly reduced the HBL and ΔHb in NFSD patients on POD three, with no changes on POD one. In contrast, the same treatment failed to reduce the HBL and ΔHb in FSD patients, neither on POD one nor on POD three. Throughout both analytical stages, there were no statistically significant variations in coagulation metrics, venous thromboembolism, or other complications. The THA patients exhibited diverse fibrinolytic phenotypes post-surgery, identifiable by LY30. Compared to NFSD patients, FSD patients experienced significantly less blood loss and derived no benefits from the empirical antifibrinolytic therapy, emphasizing the necessity of tailoring antifibrinolysis treatment.