Application Of Thrombelastography(TEG) In Assessing Risks Of Venous Thromboembolism In Perioperative Period Of Arthroplasty

BackgroundVenous thromboembolism(VTE)including deep venous thrombosis and pulmonary embolism in perioperative period of elective primary total knee and total hip arthroplasty are associated with hypercoagulable state.Thromboelastography(TEG)records the continuous change of whole blood coagulation and provides a comprehensive assessment of haemostatic function.However,TEG has not been widely applied in monitoring haemostatic state in perioperative period of elective primary total knee and total hip arthroplasty.ObjectiveWe compare similarities and differences of TEG parameters and PT,APTT in detecting preoperative haemostatic state.According to difference of haemostatic state of each patient and change of TEG parameters and hemoglobin levels,we take individualized anticoagulant therapies.Methods87 people with hip or knee diseases awaiting arthroplasty were recruited.Hemoglobin levels and TEG parameters including R,K,aangle,MA,CI were assessed in perioperative period.PT and APTT were assessed pre-operatively.For 65 patients with normal TEG parameters,PT and APTT,we use tranexamic acid to reduce blood loss during operation.As hypercoagulability group,12 patients awaiting unilateral total knee arthroplasty with hypercoagulable state assessed by TEG parameters or risks for VTE received low molecular heparin until 24 hours pre-operatively and did not receive tranexamic acid during operation.All patients received oral administration of rivaroxaban(10mg)postoperatively to prevent DVT or/and PE until 35 days postoperatively.ResultsTEG parameters have significant relationships with activated partial thromboplastin time(APTT),fibrinogen(FIB)and platelet count.The number of patients with abnormal haemostatic state assessed by TEG parameters is higher than that assessed by APTT.TEG parameters demonstrate hypercoagulability is in continued progress in perioperative period.There was no significant difference in hemoglobin concentration between hypercoagulability group and normal" group in patients receiving unilateral total knee arthroplasty.ConclusionsTEG parameters have significant relevance to APTT and higher sensitivity in detecting preoperative abnormal haemostatic state.For patients with preoperative hypercoagulability and higher risks of VTE,individualized anticoagulant therapies such as preoperative administration of low molecular heparin and not using tranexamic acid in operation did not increase blood loss while decreasing potential risks for VTE,which proves this method is safe and effective.Therefore,TEG can play an important role in VTE assessment and prevention in perioperative period of arthroplasty.