The Perioperative Changes And Clinical Significance Of Thrombelastography In Elder Patients Undergoing Lumbar Surgery

Research backgroundVenous thromboembolism(VTE)such as deep vein thrombosis(DVT),pulmonary embolism(PE),and myocardial infarction occur frequently after major orthopaedic surgery,can increase the incidence of postoperative complications and medical costs.lower extremity surgery,trauma,extended bed rest,cancer,obesity and the age are the most common perioperative risk factors for VTE.The incidence of venous VTE in patients without prophylactic anticoagulation varied between different surgical populations,ranging between 20% to 25% in open meniscectomy and 75% to 80% in knee replacement or traumatic spinal cord damage.VTE may also occur in patients who receive prophylactic coagulation,of which usually with low standard laboratory coagulation tests predictability.Compared with major non-spinal orthopaedic surgery,spinal surgery has a relative low incidence of symptomatic DVT due to factors such as operation requirements,operation time,postoperative hematoma formation,and bed rest time.However,there is no clear clinical guide to for postoperative anticoagulation time and drug dosage.Virchow discovered a triple-associated-factor with VTE in 1856,demonstrating that hypercoagulation is associated with the pathogenesis of VTE.There is no routine coagulation test in clinic to detect high coagulation status directly.The thrombelastography(TEG)is a new technique which can evaluate hemostasis use quickly and comprehensively through whole blood.It is used in clinic to detect and quantify low coagulation state or a hypercoagulable state,fibrinolysis,clot strength and anticoagulant drug effects.Therefore,this study conducted a systematic study to evaluate the diagnostic accuracy of TEG in predicting VTE in elder patients undergoing lumbar surgery.ObjectiveThis study mainly used TEG and routine coagulation programs to study the perioperative coagulation changes in elder patients who underwent lumbar surgery,and to compare the pros and cons of conventional programs and TEG in assessing coagulation function and provide reasonable preventive anticoagulant therapy after surgery,finally to serve basic clinical evidence.MethodsSelect elder patients undergoing open lumbar posterior surgery in our hospital from June 2016 to December 2017 in our hospital.Preoperative examinations to ensure tolerance of surgery.The ASA?-?,without obvious anemia,and select 5 healthy volunteers Randomly.Blood coagulation items and TEG were detected routinely on the 1st,3rd,and 7th day after operation in both groups of admissions.The results of the two groups were recorded and compared.Results1.There was no significant difference between the two groups in routine coagulation and TEG indicators(P>0.05).2.The coagulation function of patients after operation was significantly increased compared with preoperative(P<0.05),and postoperative hypercoagulability factors were not the same at different time points.3.Routine blood coagulation test and changes of TEG parameters in patients after 1,3,and 7 days after operation indicated that the change of coagulation function was significant(P<0.05).4.The detection rates of postoperative hypercoagulable TEG in patients at different points were better than that of conventional coagulation group with T1: 66.7%> 47.2%,T2:50%> 19.4%,T3: 83.3%> 58.3%.Conclusion1.There is no significant effect on the coagulation status of spine after coagulation and TEG examination in age,BMI,gender,etc.2.TEG can reflect the early coagulation changes effectively after spinal surgery.3.Hypercoagulability is mainly expressed by coagulation factors after spinal surgery over time,and gradually turns to mixed hypercoagulation caused by platelet expression.4.The detection rate of TEG in the hypercoagulable state after spinal surgery was significantly higher than that of conventional coagulation.5.Prophylactic anticoagulant therapy is recommended for patients after spinal surgery.