{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T15:14:25Z","timestamp":1783610065512,"version":"3.55.0"},"reference-count":34,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T00:00:00Z","timestamp":1783555200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Tourniquet use during total knee arthroplasty (TKA) improves surgical visualization and limits blood loss but may also trigger ischemia\u2013reperfusion-related hemodynamic instability. This study investigated coagulation and inflammatory responses after tourniquet release and their association with perioperative hemodynamic instability. Methods: This prospective observational cohort study included 22 patients aged 65\u201390 years undergoing unilateral TKA. Hemodynamic parameters, coagulation markers (D-dimer, INR, APTT), and inflammatory markers were measured at predefined perioperative time points. Hemodynamic instability was assessed using the modified shock index (MSI = HR\/MAP). Non-parametric statistical analyses were performed. Results: The D-dimer and INR increased significantly after tourniquet release and remained elevated at 24 h (p &lt; 0.001). APTT prolongation was transient (p = 0.001). The NLR and SII increased both early and late, whereas CRP showed a delayed rise. \u0394 analysis demonstrated temporal changes in coagulation parameters; however, no significant between-group differences according to MSI status were identified. Although \u0394Peak IL-6 was higher in the unstable group, the difference was not statistically significant (p = 0.097). ROC analysis demonstrated moderate discriminative performance for \u0394Peak IL-6 (AUC = 0.747), whereas the NLR (AUC = 0.471), SII (AUC = 0.529), and CAI (AUC = 0.482) showed poor predictive performance for hemodynamic instability. Conclusions: Tourniquet release induces significant coagulation and inflammatory responses following total knee arthroplasty. Although no definitive biomarker of hemodynamic instability was identified, \u0394Peak IL-6 showed a trend toward association with instability and may merit further investigation. These findings suggest a possible interaction between inflammatory and coagulation pathways after tourniquet release and should be validated in larger prospective studies.<\/jats:p>","DOI":"10.3390\/jcm15145386","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T14:17:51Z","timestamp":1783606671000},"page":"5386","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Coagulation and Inflammatory Responses After Tourniquet Release in Total Knee Arthroplasty: Association with Hemodynamic Instability"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2769-8157","authenticated-orcid":false,"given":"Fatma","family":"Acil","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Diyarbak\u0131r SB\u00dc Gazi Ya\u015fargil Training and Research Hospital, Diyarbak\u0131r 21010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5616-8625","authenticated-orcid":false,"given":"Cemal","family":"Nas","sequence":"additional","affiliation":[{"name":"Department of Biochemistry, Diyarbak\u0131r SB\u00dc Gazi Ya\u015fargil Training and Research Hospital, Diyarbak\u0131r 21010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anda\u00e7","family":"Dedeo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Diyarbak\u0131r SB\u00dc Gazi Ya\u015fargil Training and Research Hospital, Diyarbak\u0131r 21010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3299-7349","authenticated-orcid":false,"given":"H\u00fclya","family":"Tosun S\u00f6ner","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Diyarbak\u0131r SB\u00dc Gazi Ya\u015fargil Training and Research Hospital, Diyarbak\u0131r 21010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali \u0130hsan","family":"Y\u00fcrekli","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Diyarbak\u0131r SB\u00dc Gazi Ya\u015fargil Training and Research Hospital, Diyarbak\u0131r 21010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kutbettin","family":"Din\u00e7er","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Diyarbak\u0131r SB\u00dc Gazi Ya\u015fargil Training and Research Hospital, Diyarbak\u0131r 21010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-1711-1311","authenticated-orcid":false,"given":"Cahit","family":"Ancar","sequence":"additional","affiliation":[{"name":"Department of Orthopedics and Traumatology, Diyarbak\u0131r SB\u00dc Gazi Ya\u015fargil Training and Research Hospital, Diyarbak\u0131r 21010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4945-9328","authenticated-orcid":false,"given":"Erhan","family":"G\u00f6k\u00e7ek","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Diyarbak\u0131r SB\u00dc Gazi Ya\u015fargil Training and Research Hospital, Diyarbak\u0131r 21010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulkadir","family":"Yekta\u015f","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Reanimation, Diyarbak\u0131r SB\u00dc Gazi Ya\u015fargil Training and Research Hospital, Diyarbak\u0131r 21010, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1672","DOI":"10.1016\/S0140-6736(18)32344-4","article-title":"Knee replacement","volume":"392","author":"Price","year":"2018","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.2106\/JBJS.17.01617","article-title":"Projected Volume of Primary Total Joint Arthroplasty in the U.S., 2014 to 2030","volume":"100","author":"Sloan","year":"2018","journal-title":"J. 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