Tocilizumab treatment in patients with rheumatoid arthritis is associated with reduced fibrinogen levels and increased blood loss after total knee arthroplasty

Tocilizumab (TCZ) reported being increased risk of hemorrhage in patients with rheumatoid arthritis (RA). However, no study has directly compared TCZ treated other-treated RA patients undergoing total knee arthroplasty (TKA) about the volume of perioperative bleeding. Therefore in the present study, it was demonstrated that TCZ treatment in patients with RA might increase the risk of blood loss after TKA because of decreased fibrinogen levels.

The stimulation of the coagulation cascade and upregulation of fibrinogen transcription significantly associated with IL-6, the study aimed to test the hypothesis that the RA patients received tocilizumab (TCZ) may lose more blood while going through total knee arthroplasty (TKA).

A total of 115 RA patients were selected. The Nadler formula used to measure the blood volume of every patient and a change between pre-operative and post-operative hematocrits to measure estimated blood loss after TKA. In the case of reinfused salvaged blood, the volume was assessed and combined to the volume of the estimated blood loss.

Lower pre-operative fibrinogen levels were noticed among the individuals treated with TCZ as compared to those not treated with TCZ. Also, the patients with TCZ treatment showed a statistically significant increase in mean total volume of estimated blood loss after TKA.

The risk of blood loss after TKA increase among the patients treated with TCZ due to reduced fibrinogen levels.