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Plasmin, Immunity, and Surgical Site Infection

SSI are a universal economic burden and increase individual patient morbidity and mortality. While antibiotic prophylaxis is the primary preventative intervention, these agents are not themselves benign and may be less effective in the context of emerging antibiotic resistant organisms. Exploration...

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Detalles Bibliográficos
Autores principales: Hastings, Stuart, Myles, Paul S., Medcalf, Robert L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150767/
https://www.ncbi.nlm.nih.gov/pubmed/34065949
http://dx.doi.org/10.3390/jcm10102070
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author Hastings, Stuart
Myles, Paul S.
Medcalf, Robert L.
author_facet Hastings, Stuart
Myles, Paul S.
Medcalf, Robert L.
author_sort Hastings, Stuart
collection PubMed
description SSI are a universal economic burden and increase individual patient morbidity and mortality. While antibiotic prophylaxis is the primary preventative intervention, these agents are not themselves benign and may be less effective in the context of emerging antibiotic resistant organisms. Exploration of novel therapies as an adjunct to antimicrobials is warranted. Plasmin and the plasminogen activating system has a complex role in immune function. The immunothrombotic role of plasmin is densely interwoven with the coagulation system and has a multitude of effects on the immune system constituents, which may not always be beneficial. Tranexamic acid is an antifibrinolytic agent which inhibits the conversion of plasminogen to plasmin. Clinical trials have demonstrated a reduction in surgical site infection in TXA exposed patients, however the mechanism and magnitude of this benefit is incompletely understood. This effect may be through the reduction of local wound haematoma, decreased allogenic blood transfusion or a direct immunomodulatory effect. Large scale randomised clinical trial are currently being undertaken to better explain this association. Importantly, TXA is a safe and widely available pharmacological agent which may have a role in the reduction of SSI.
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spelling pubmed-81507672021-05-27 Plasmin, Immunity, and Surgical Site Infection Hastings, Stuart Myles, Paul S. Medcalf, Robert L. J Clin Med Review SSI are a universal economic burden and increase individual patient morbidity and mortality. While antibiotic prophylaxis is the primary preventative intervention, these agents are not themselves benign and may be less effective in the context of emerging antibiotic resistant organisms. Exploration of novel therapies as an adjunct to antimicrobials is warranted. Plasmin and the plasminogen activating system has a complex role in immune function. The immunothrombotic role of plasmin is densely interwoven with the coagulation system and has a multitude of effects on the immune system constituents, which may not always be beneficial. Tranexamic acid is an antifibrinolytic agent which inhibits the conversion of plasminogen to plasmin. Clinical trials have demonstrated a reduction in surgical site infection in TXA exposed patients, however the mechanism and magnitude of this benefit is incompletely understood. This effect may be through the reduction of local wound haematoma, decreased allogenic blood transfusion or a direct immunomodulatory effect. Large scale randomised clinical trial are currently being undertaken to better explain this association. Importantly, TXA is a safe and widely available pharmacological agent which may have a role in the reduction of SSI. MDPI 2021-05-12 /pmc/articles/PMC8150767/ /pubmed/34065949 http://dx.doi.org/10.3390/jcm10102070 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Hastings, Stuart
Myles, Paul S.
Medcalf, Robert L.
Plasmin, Immunity, and Surgical Site Infection
title Plasmin, Immunity, and Surgical Site Infection
title_full Plasmin, Immunity, and Surgical Site Infection
title_fullStr Plasmin, Immunity, and Surgical Site Infection
title_full_unstemmed Plasmin, Immunity, and Surgical Site Infection
title_short Plasmin, Immunity, and Surgical Site Infection
title_sort plasmin, immunity, and surgical site infection
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8150767/
https://www.ncbi.nlm.nih.gov/pubmed/34065949
http://dx.doi.org/10.3390/jcm10102070
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