Elsevier

The Lancet

Volume 316, Issue 8196, 27 September 1980, Pages 663-667
The Lancet

ENHANCED IN-VIVO PLATELET RELEASE REACTION, INCREASED THROMBOXANE SYNTHESIS, AND DECREASED PROSTACYCLIN RELEASE AFTER TOURNIQUET ISCHAEMIA

https://doi.org/10.1016/S0140-6736(80)92706-3Get rights and content

Abstract

Plasma β -thromboglobulin (β-TG), a marker of in-vivo platelet release reaction, was measured in 27 meniscectomy patients, 10 patients who underwent total knee replacements (TKR) (both procedures performed under tourniquet ischæmia), and 10 herniorrhaphy patients. In 22 meniscectomy and 7 TKR patients plasma-thromboxane-B2 (TxB2), a stable end-product of thromboxane-synthetase activity, was also determined. The mean plasma β-TG and TxB2 had risen significantly within 5 min of release of the tourniquet, indicating increased in-vivo platelet release reaction and prostaglandin synthesis in these patients. In the herniorrhaphy patients β-TG and TxB2 did not alter significantly postoperatively. In 6 pigs (weighing 20-30 kg) who underwent meniscectomy under tourniquet ischæmia plasma TxB2 rose significantly 15-30 min after release of the tourniquet, and prostacyclin release was significantly lower from veins exposed to ischæmia than from control veins. Large de-endothelialised areas were seen on scanning electron-micrographic sections of affected veins, and these areas were covered with a monolayer of platelets and platelet clumps. These changes associated with tourniquet ischæmia may explain the high incidence of venous thrombosis seen in patients undergoing meniscectomy and TKR.

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