Clinical significance of thromboelastography and D-dimer in the assessment of thrombosis after vertebral augmentation

Abstract

Objective To explore changes in coagulation function, assessed by thromboelastography(TEG)combined with D-dimer(D-D), in patients undergoing percutaneous vertebroplasty(PVP)or percutaneous kyphoplasty(PKP). Methods A total of 52 elderly patients with osteoporosis-associated vertebral compression fractures admitted into our hospital from May 2016 to November were enrolled in this study, including 13 men aged 64-91 years, with a mean age of(74.3±10.5)years, and 39 women aged 60-89 years, with a mean age of(71.4±7.3)years.Patients received vertebroplasty under local anesthesia, with 29 patients undergoing PVP and 23 cases taking PKP.Thromboelastography(TEG)and D-dimer(D-D)levels were measured at 1 h before, 0.5 h, 1 h and 3 h after bone cement injections, in order to analyze changes in patients' coagulation function. Results Compared with the coagulation parameters in patients 1 h before bone cement injections, the values of R, K, Angle, Ma, CI, EPL, LY30 and D-D had no significant difference in patients 0.5 h after bone cement injections(P>0.05); the values of R, Angle, CI, EPL and LY30 were significantly different(P 0.05)in patients 1 h after bone cement injections; the values of R, K, Angle, Ma, CI, LY30 and D-D had no significant difference(P>0.05), but the value of EPL was significantly different in patients 3 h after bone cement injections(P<0.05). Conclusions The blood is in a transient hypercoagulable state during the time of 0.5 h to 3 h after PVP or PKP, which reaches the peak at the time of 1 h after operation, thereby increasing the risk of thrombosis.Therefore, some interventions such as anticoagulants could be carried out during the preoperative and postoperative period.Changes in coagulation function should be closely monitored after operation.Patients should start postoperative exercise early. Key words: Fracture, bone; D-dimer; Vertebroplasty; Thrombosis