Is pre-operative assessment of coagulation profile with Thrombelastography (TEG) useful in predicting venous thromboembolism (VTE) following orthopaedic surgery?

Parameswaran, Apurve; Krishnamoorthy, Vignesh P.; Oommen, Anil Thomas; Jasper, Anita; Korula, Roy John; Nair, Sukesh C.; Poonnoose, Pradeep Mathew

doi:10.1016/j.jcot.2016.08.003

Cited by 20 publications

(19 citation statements)

References 25 publications

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“…Thromboelastography (TEG) is a whole-blood assay that can identify both hypocoagulable and hypercoagulable states [ 30 , 31 ]. Elevated levels of the TEG assay at admission have been found to be predictive of PE in general trauma patients [ 31 ].…”

Section: Risk Assessmentmentioning

confidence: 99%

Venous thromboembolism prophylaxis after hip preservation surgery: a review and presentation of institutional experience

Rezaie

Azboy

Parvızı

2018

Journal of Hip Preservation Surgery

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Venous thromboembolism (VTE) is a serious complication after major orthopedic procedures. The best options for prevention of the VTE are still debated. The most popular evidence-based guidelines for prevention and treatment of VTE in orthopedic surgery addressed the total hip or knee arthroplasty and hip fractures as the major orthopedic surgeries. Majority of studies have evaluated the different modalities of the VTE prophylaxis in patients undergiong hip or knee arthroplasty. Hip preservation surgeries (HPS) including mini-open femoroacetabular osteoplasty, surgical dislocation of the hip, arthroscopic procedures, and periacetabular osteotomy (PAO) are gained popularity in recent two decades. The majority of these patients are young, healthy and active and may not be considered at high risk for VTE. The frequency of VTE in patients undergoing PAO seems to be low between 0 and 5%. There is a paucity of data regarding rates of VTE in young healthy patients undergoing HPS as well as the optimal prevention methods for VTE. Hence current VTE prevention guidelines do not cover HPS adequately. We aimed to review the available literature regarding VTE events and VTE prophylaxis options after HPS. We discussed the available and potential options for prophylaxis of VTE events in these procedures along with our experience in a large cohort of hip preservation surgery.

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Section: Risk Assessmentmentioning

confidence: 99%

Venous thromboembolism prophylaxis after hip preservation surgery: a review and presentation of institutional experience

Rezaie

Azboy

Parvızı

2018

Journal of Hip Preservation Surgery

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“…And TEG is a useful adjunctive test for assessment of thrombophilia, even if conventional thrombophilia screen methods were normal. (18) However, to our knowledge, only a handful of studies in the literature have reported coagulation monitoring by TEG following primary arthroplasty (9,19,20,23,24) but there is no data regarding TEG after revision arthroplasty on ERAS.…”

Section: Discussionmentioning

confidence: 99%

“…(17,18) Besides, TEG is potentially useful in predicting which patients will develop thromboembolic complications and abnormal bleeding. (14,19,20) However, to the best of our knowledge, there was no study published about the TEG use following revision THA. Therefore, the objective of this study is to determine changes in coagulability as measured by TEG following revision total hip arthroplasty when the patients received rivaroxaban and tranexamic acid in the perioperative period during ERAS.…”

Section: Introductionmentioning

confidence: 99%

Changes in coagulation status as measured by thromboelastography in patients undergoing revision total hip arthroplasty

Yang

Zhu

Qin

et al. 2020

Preprint

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Background: Venous thromboembolism events (VTEs) continue to be of the most widespread severe complication following total hip arthroplasty (THA) and total knee arthroplasty (TKA). However, there are no optimal accurate monitoring methods to assess the changes in coagulability after anticoagulation and anti-fibrinolysis during the perioperative period. Therefore, the objective of this study is to determine changes in coagulability as measured by thromboelastography (TEG) following revision total hip arthroplasty when the patients received rivaroxaban and tranexamic acid in perioperative period during enhanced recovery after surgery (ERAS). Methods: We retrospectively reviewed 70 revision TKA patients (mean age 63.69±10.17 years). Perioperative management of each patient was conducted in accordance with ERAS. The patients received tranexamic (TXA) to control perioperative bleeding. TEG was performed pre-operatively and on post-operative days (POD) 1, 3, 5 and 7. TEG-hypercoagulability was classified into three types: enzymatic hypercoagulability, platelet hypercoagulability and mixed hypercoagulability. Screening for coagulation-related complications at three months of follow-up. Results: The mean duration of surgery was 2.91±0.99 h. the mean intraoperative blood loss of patients was 486.43±346.92 ml. And 55.71% (39) patients received transfusion, the mean blood transfusion volume was 482.86 ± 458.79 ml. There only were 4 (5.71%) patients who suffered postoperative coagulation-related complications. 1 patient with hypercoagulable on preoperative developed intramuscular venous thrombosis at 1 month postoperatively. 1 patient with hypercoagulability at POD5 and POD7 suffered melena at POD5. 2 patients with hypocoagulability developed ecchymosis at POD3. The proportion of postoperative hypercoagulable state is gradually increasing. The distribution of different hypercoagulable states on the postoperative day (POD) 5 and 7 were significantly different from that pre-operation (Pre) and POD1 (POD5 vs Pre: p=0.011; POD5 vs POD1: p=0.001; POD7 vs Pre: p=0.001; POD7 vs POD5: p<0.001). We found 32.86%(23) revision THA with hypercoagulable state on POD7.For 78.26%(18) of these patients there was mixed hypercoagulability. Conclusions: In ERAS, thromboelastography was an effective way to identify hypercoagulable state in patients undergoing revision hip arthroplasty, and mixed hypercoagulability is the predominant hypercoagulable state following revision hip arthroplasty. In addition, it is very important to develop an individualized coagulation management program.

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“…Частота развития ВТЭО у пациентов со скелетной травмой высока, а при отсутствии профилактики она достигает 50% [12][13][14][15][16]. Более чем у 1 / 3 пациентов с переломами шейки бедра в предоперационном периоде выявляют ТГВ нижних конечностей [12,15].…”

Section: ведение пациентов с втэо на фоне костной травмы требующей нunclassified

The Management of the Patients with Deep Vein Thrombosis in Need of Emergency Surgical Intervention

Efremova¹,

Andriyashkin²,

Vasil'ev³

et al. 2017

Flebol.

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Кафедра факультетской хирургии №1 (зав.-член-корр. РАН, проф. А.В. Сажин) лечебного факультета Российского национального исследовательского медицинского университета им. Н.И. Пирогова Минздрава России, Москва, Россия Случаи развития венозных тромбоэмболических осложнений (ВТЭО) у пациентов стационаров рассматривают как осложнение не только острых патологических состояний, но и хронических заболеваний или различных лечебных мероприятий. Вероятность развития венозного тромбоза и легочной эмболии у пациентов, находящихся на стационарном лечении, гораздо выше, чем в остальных ситуациях. У пациентов с различными травматическими повреждениями костей скелета, а также после перенесенного оперативного лечения костной травмы, частота развития венозного тромбоза колеблется от 40 до 60%, а в случаях множественной или сочетанной травмы может достигать и 80%. У пациентов с хирургическими заболеваниями или перенесших большие урологические или гинекологические операции ВТЭО развиваются в 15-40% случаев. Около 20% случаев ВТЭО ассоциировано с каким-либо онкологическим заболеванием, при этом в 3-12% таких наблюдений может быть обнаружен бессимптомный венозный тромбоз. Несмотря на адекватно проводимую профилактику ВТЭО, частота развития венозных тромбозов у стационарных пациентов остается довольно высокой (16,1%), а если профилактика отсутствует или проводится неадекватно, венозный тромбоз выявляется у 45-59% больных. Развитие венозного тромбоза у пациентов с какой-либо хирургической патологией делает опасным выполнение необходимого оперативного лечения основного заболевания за счет высокого риска периоперационной тромбоэмболии легочных артерий. В большинстве случаев вопрос об оперативном вмешательстве откладывают до достижения реканализации глубоких вен. Подобное промедление приводит к развитию осложнений как основного, так и сопутствующих заболеваний, а также к прогрессированию венозного тромбоза. В то же время высокий риск геморрагических осложнений во многих случаях делает невозможным проведение адекватной антикоагулянтной терапии. В обзоре литературы представлены известные на сегодняшний день данные об эффективности и безопасности хирургических вмешательств на опорно-двигательном аппарате и по поводу новообразований брюшной полости и забрюшинного пространства у больных с симультанным острым венозным тромбозом и/или легочной эмболией. Ключевые слова: венозные тромбоэмболические осложнения, симультанный тромбоз глубоких вен, неотложная хирургия, антикоагулянтная терапия

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Is pre-operative assessment of coagulation profile with Thrombelastography (TEG) useful in predicting venous thromboembolism (VTE) following orthopaedic surgery?

Cited by 20 publications

References 25 publications

Venous thromboembolism prophylaxis after hip preservation surgery: a review and presentation of institutional experience

Venous thromboembolism prophylaxis after hip preservation surgery: a review and presentation of institutional experience

Changes in coagulation status as measured by thromboelastography in patients undergoing revision total hip arthroplasty

The Management of the Patients with Deep Vein Thrombosis in Need of Emergency Surgical Intervention

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