Published online Aug 18, 2021. doi: 10.5312/wjo.v12.i8.555
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
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.
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.
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.
We performed a retrospective, observational study, examining archived data of elective THA patients. Patients were selected from a dedicated orthopedic preadmis
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.
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.
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.