Abstract
BackgroundThere has been no effective method to monitor the changes of blood coagulation after thromboprophylaxis for elective arthroplasty patients. The objective of this study is to assess the coagulation status of patients undergoing arthroplasty with thromboelastograph (TEG).MethodsNinety patients undergoing primary elective unilateral arthroplasty were investigated. Thromboprophylaxis continued for at least 10 days. TEG was performed on the day before the operation and on postoperative days 1, 4, and 9.ResultsThe total hip and total knee groups showed significant changes in the distribution of different hypercoagulable states on days 1–4 and on days 4–9. On day 9 after operation, 34 out of 90 (37.8%) of the total hip and total knee patients were found with hypercoagulable state. Of these 34 patients with hypercoagulable state, 26 (76.5%) demonstrated platelet or mixed hypercoagulability.ConclusionsThrombelastography was an effective way to identify hypercoagulability in patients undergoing elective primary total knee and total hip replacement. Platelet may play an important role in the progress of blood hypercoagulability.
Highlights
There has been no effective method to monitor the changes of blood coagulation after thromboprophylaxis for elective arthroplasty patients
None of the patients has a history of heparin-induced thrombocytopenia (HIT) or kidney insufficiency (CrCl < 30 ml/min)
All total knee and total hip replacements were performed by the same group of surgeons, Genesis II knee system of Smith & Nephew was used in the knee replacements, Synergy hip system of Smith & Nephew, and Summit hip system of Johnson & Johnson were used in the hip replacements
Summary
There has been no effective method to monitor the changes of blood coagulation after thromboprophylaxis for elective arthroplasty patients. Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a severe complication in major orthopedic surgery. With the routine use of thromboprophylaxis, some patients still develop DVT of the lower extremity and PE, while a minority of them may be at Thromboelastograph (TEG) is a point-of-care test for evaluation of hemostasis, which has been widely used in the field of liver transplantation and coronary bypass surgery as an intraoperative hemostatic monitoring device [5,6,7]. Monitoring blood coagulation with thromboelastograph had not gained popularity in the field of orthopedics [9,10]
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