The application of thromboelastography in risk stratification for selective thromboembolism prophylaxis after total joint arthroplasty in Chinese: a randomized controlled trial

Chen, Ziming; Ma, Yuanfang; Li, Qingtian; Deng, Zhong‐Liang; Zheng, Qiujian

doi:10.21037/apm-19-385

Cited by 4 publications

(5 citation statements)

References 37 publications

(47 reference statements)

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“…Biased correlation analysis after controlling for age suggested that as testosterone decreased in men with diabetes, K values decreased and Angle, MA values, and CL values increased. Increased MA values suggested an increased risk of thrombosis, consistent with the results of previous studies ( Chen et al, 2020 ). Considering that reduced testosterone levels can lead to increased blood coagulation activity and inhibition of fibrinolytic activity, hypercoagulation occurs ( Si & Li, 2005 ).…”

Section: Discussionsupporting

confidence: 91%

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Analysis of Sex Hormones, Insulin Dosage, and Risk Factors Associated With Male Diabetic Patients

Chen

2024

Am J Mens Health

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The purpose of this study is to assess the influence of sex hormones and other indicators on risk factors for hypercoagulable states in male patients with type 2 diabetes mellitus. Ninety-two diabetic patients were divided into two groups based on testosterone levels: T1 group (testosterone <12 mmol/L) and T2 group (testosterone >12 mmol/L). Fifty-four non-diabetic patients were used as the control group. Sex hormone index, glucose, insulin, C-peptide, 24-h urinary free cortisol, thromboelastography, and insulin resistance index were measured by radioimmunoassay. Testosterone was lower in the diabetic men than in the control group (12.02 vs 14.77, p < .05), and was inversely related to blood coagulation status, blood glucose level, and cortisol level. Body mass index was positively correlated with estradiol and insulin resistance index. Testosterone was independently associated with the clotting process after controlling for age. Low testosterone is a risk factor for hypercoagulable state in diabetic men. Elevated estradiol and insulin resistance are influential factors for increased body mass index.

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Section: Discussionsupporting

confidence: 91%

Section: Thromboelastographysupporting

confidence: 91%

Analysis of Sex Hormones, Insulin Dosage, and Risk Factors Associated With Male Diabetic Patients

Chen

2024

Am J Mens Health

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“…DEX can maintain a certain level of sedation, has the advantage of not causing respiratory depression, and is easy to awaken from[ 19 , 20 ]. DEX, which belongs to the imidazole derivative class, exerts its sedative effect by stimulating the alpha-2C receptor subtype, which synergizes with opioid drugs and reduces the required dose of opioid medications[ 21 , 22 ]. This drug has a relatively short duration of action, improves cardiovascular stability during surgery, and reduces the incidence of agitation.…”

Section: Discussionmentioning

confidence: 99%

Combined use of dexmedetomidine and nalbuphine in laparoscopic radical gastrectomy for gastric cancer

Zhao,

Lou,

Gao

et al. 2024

World J Gastrointest Oncol

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BACKGROUND Radical laparoscopic gastrectomy is an important treatment modality for gastric cancer. Surgery requires general anesthesia, and patients are susceptible to the effects of anesthetic drugs and carbon dioxide insufflation during the procedure, leading to inflammation or severe pain, which can affect patient outcome. AIM To explore the efficacy of combining dexmedetomidine (DEX) with nalbuphine in patients underwent laparoscopic radical gastrectomy for gastric cancer. METHODS Patients scheduled to undergo laparoscopic radical gastrectomy were selected and randomly assigned to A or B group. In A group, patients received an intravenous injection of nalbuphine 0.2 mg/kg + DEX 0.4 μg/kg 10 min before the end of surgery; in B group, patients received only an intravenous injection of nalbuphine. The trends in hemodynamic parameter fluctuations, awakening quality during the recovery period, serum inflammatory markers, agitation scores, cough severity, incidence, and duration of postoperative delirium (POD) were compared. RESULTS The mean arterial pressure and heart rate in the A group were more stable (P < 0.05). The A group had a lower average awakening time, extubation time, and agitation scores during recovery than the B group. Agitation control in the A group was more effective at different time points (P < 0.05). Patients in the A group had lower serum interleukin (IL)-6, tumour necrosis factor alpha, and IL-10 levels at 1 h after surgery than the B group. The incidence of coughing and duration of POD were lower and shorter in the A group than in the B group. Adverse reactions caused by the two anesthesia methods were less frequent in the A group than in the B group (P < 0.05). CONCLUSION The use of DEX and nalbuphine in patients undergoing laparoscopic radical gastrectomy for gastric cancer help reducing the inflammatory response, cough severity, and agitation and helps maintain hemodynamic stability.

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“…When it comes to anticoagulation, TEG has been established to differentiate anticoagulated patients as well as monitor their therapy [ 60 - 62 ]. TEG-guided anticoagulation prophylaxis has better safety and comparable efficacy to conventional prophylaxis strategy [ 63 ]. TEG did not find any significance in detecting specific outcomes related to orthopedic surgery such as bone cement implantation syndrome and infections [ 64 , 65 ] (Table 5 ).…”

Section: Reviewmentioning

confidence: 99%

Thromboelastography in the Perioperative Period: A Literature Review

Ramanujam¹,

DiMaria²,

Varma³

2023

Cureus

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Assessing coagulation status is essential for prompt intervention to reduce morbidity and mortality related to bleeding and thrombotic complications during the perioperative period. Traditional coagulation tests such as platelet count, activated partial thromboplastin time (aPTT), prothrombin time (PT), international normalized ratio (INR), and activated clotting time (ACT) provide only static evaluation. These tests are not designed for assessment of dynamically changing coagulation conditions during the perioperative time. However, viscoelastic coagulation testing such as thromboelastography (TEG) produces a rapid numerical and graphical representation that helps to detect and direct targeted hemostatic therapy. Searching the literature through PubMed, Medline, Ovid, CINAHL, and ClinicalTrials.gov we retrieved 210 studies, which represent the use of TEG in the perioperative period. The included studies were categorized under various settings such as trauma, obstetrics, orthopedics, intensive care unit (ICU), cardiovascular, transplant, and miscellaneous scenarios. TEG showed promising results in trauma surgeries in predicting mortality, hypercoagulability, and bleeding even when it was compared to conventional methods. TEG was also useful in monitoring anticoagulant therapy in orthopedic and obstetric surgeries; however, its role in predicting thrombotic events, hypercoagulability, or complications was questionable. In ICU patients, it showed promising results, especially in the prediction or improvement of sepsis, coagulopathy, thrombotic events, ICU duration, hospital stay, and ventilator duration. TEG parameters effectively predicted hypercoagulation in transplant surgeries. Regarding cardiovascular surgeries, they were effective in the prediction of the need for blood products, coagulopathy, thrombotic events, and monitoring anticoagulation therapy. More randomized clinical trials comparing TEG parameters with standardized tools are needed to produce robust results to standardize its use in different perioperative settings.

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The application of thromboelastography in risk stratification for selective thromboembolism prophylaxis after total joint arthroplasty in Chinese: a randomized controlled trial

Cited by 4 publications

References 37 publications

Analysis of Sex Hormones, Insulin Dosage, and Risk Factors Associated With Male Diabetic Patients

Analysis of Sex Hormones, Insulin Dosage, and Risk Factors Associated With Male Diabetic Patients

Combined use of dexmedetomidine and nalbuphine in laparoscopic radical gastrectomy for gastric cancer

Thromboelastography in the Perioperative Period: A Literature Review

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