Lloyd-Donald P, Lee WS, Liu GM, Bellomo R, McNicol L, Weinberg L. Thromboelastography in elective total hip arthroplasty. World J Orthop 2021; 12(8): 555-564 [PMID: 34485102 DOI: 10.5312/wjo.v12.i8.555]
Corresponding Author of This Article
Laurence Weinberg, BSc, MBChB, MD, MRCP, Associate Professor, Director, Doctor, Staff Physician, Department of Anesthesia, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia. laurence.weinberg@austin.org.au
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Patryck Lloyd-Donald, Wen-Shen Lee, Guo-Ming Liu, Larry McNicol, Laurence Weinberg, Department of Anesthesia, Austin Health, Heidelberg 3084, Victoria, Australia
Rinaldo Bellomo, Department of Intensive Care, Austin Hospital, Melbourne 3084, Victoria, Australia
Laurence Weinberg, Department of Surgery, The University of Melbourne, Austin Health, Melbourne 3084, Victoria, Australia
Author contributions: McNicol L and Liu GM were the main authors responsible for study design; Patients were primarily recruited, and data collection performed, by Liu GM and McNicol L; This existing data was inherited and analyzed primarily by Lee WS, McNicol L, Lloyd-Donald P and Weinberg L; The bulk of the manuscript was drafted by Lloyd-Donald P, Lee WS, Bellomo R and Weinberg L; all authors read and approved the final manuscript.
Institutional review board statement: The Austin Health Research and Ethics Committee approved this retrospective study (HREC ref number: LNR/19/Austin/21).
Informed consent statement: The informed consent was waived.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Original data is contained on old Minitab (.mtw) files that have compatibility issues with recent versions.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Laurence Weinberg, BSc, MBChB, MD, MRCP, Associate Professor, Director, Doctor, Staff Physician, Department of Anesthesia, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia. laurence.weinberg@austin.org.au
Received: February 15, 2021 Peer-review started: February 15, 2021 First decision: May 6, 2021 Revised: May 21, 2021 Accepted: July 9, 2021 Article in press: July 9, 2021 Published online: August 18, 2021 Processing time: 176 Days and 23.5 Hours
ARTICLE HIGHLIGHTS
Research background
Patients undergoing total hip arthroplasty (THA) are known to be at high risk of developing venous thromboembolism (VTE), causing significant morbidity and mortality. Thromboelastography (TEG) offers real-time information regarding the global coagulation state of a patient. This technology may be useful in investigating the coagulation of this high-risk population.
Research motivation
Available evidence surrounding the use of TEG in this patient cohort is limited, including both observational data, describing the coagulation status in these patients, and interventional data, guiding anticoagulant therapy. Our motivation for this study was to investigate the coagulation state observed in this patient group as assessed by TEG, and examine how these observations change according to time course post-operatively, and anesthetic technique, in order to ultimately improve perioperative care of these high-risk patients.
Research objectives
We aim primarily to demonstrate the coagulation profile of patients undergoing elective THA, using TEG. We secondarily aim to describe how this coagulation pattern varies according to anesthetic technique chosen [spinal neuraxial vs general anesthesia (GA)] and how TEG findings compare to traditional coagulation tests.
Research methods
We performed a retrospective, observational study, examining archived data of elective THA patients. Patients were selected from a dedicated orthopedic preadmission clinic, meeting strict inclusion criteria, and all received enoxaparin as routine post-operatively. We analyzed baseline TEG maximum amplitude (MA), compared to intraoperative and postoperative days 1, 2 and 5. We then compared observations based on anesthetic technique received (GA vs spinal) and those described by conventional coagulation tests.
Research results
We studied a total of 52 patients. We found that MA remained within normal limits, without significant difference from baseline, throughout surgery. We observed elevated MA postoperatively on days 1 and 2, before resolving day 5. This was consistent regardless of anesthetic technique used. All patients had elevated fibrinogen levels day 5 post-operatively, with no other abnormalities detected by conventional coagulation tests.
Research conclusions
Patients undergoing elective THA demonstrate postoperative hypercoagulability when assessed by TEG (characterized by elevated TEG MA), despite routine VTE prophylaxis. Anesthetic technique (spinal vs GA) had no influence on the postoperative coagulation profile observed in these patients, as assessed by TEG.
Research perspectives
Our study findings imply that routine VTE prophylaxis in patients undergoing elective THA does not ablate the postoperative hypercoagulable state, according to TEG. These findings suggest that further research comparing TEG with both conventional coagulation tests, (including platelet count) and platelet function testing may be useful.
