Changes of thrombelastography in patients undergoing elective primary total knee and total hip replacement with low mole
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RESEARCH ARTICLE
Open Access
Changes of thrombelastography in patients undergoing elective primary total knee and total hip replacement with low molecular heparin prophylaxis Yi Yang1†, Zhenjun Yao1†, Wenda Dai1, Peng Shi2, Lei luo3 and Chi Zhang1*
Abstract Background: There has been no effective method to monitor the changes of blood coagulation after thromboprophylaxis for elective arthroplasty patients. The objective of this study is to assess the coagulation status of patients undergoing arthroplasty with thromboelastograph (TEG). Methods: Ninety patients undergoing primary elective unilateral arthroplasty were investigated. Thromboprophylaxis continued for at least 10 days. TEG was performed on the day before the operation and on postoperative days 1, 4, and 9. Results: The total hip and total knee groups showed significant changes in the distribution of different hypercoagulable states on days 1–4 and on days 4–9. On day 9 after operation, 34 out of 90 (37.8%) of the total hip and total knee patients were found with hypercoagulable state. Of these 34 patients with hypercoagulable state, 26 (76.5%) demonstrated platelet or mixed hypercoagulability. Conclusions: Thrombelastography was an effective way to identify hypercoagulability in patients undergoing elective primary total knee and total hip replacement. Platelet may play an important role in the progress of blood hypercoagulability. Keywords: Thromboprophylaxis, Low molecular weight heparin, Arthroplasty, Thrombelastography, Hypercoagulability
Background Venous thromboembolism (VTE), including pulmonary embolism (PE) and deep vein thrombosis (DVT), is a severe complication in major orthopedic surgery. The incidence of venous thromboembolism following total joint replacement (TJR) has diminished over the last three decades [1]. The routine use of anticoagulants after total knee and total hip replacement is strongly recommended by, at present, the guidelines by the American Association of Chest Physicians (ACCP) [2]. However, with the routine use of thromboprophylaxis, some patients still develop DVT of the lower extremity and PE, while a minority of them may be at * Correspondence: [email protected] † Equal contributors 1 Department of Orthopaedic, Zhongshan Hospital of Fudan University, Shanghai 200032, China Full list of author information is available at the end of the article
risk for bleeding complications [2-4]. This suggests that it is important to accurately monitor the changes of coagulation after anticoagulation during perioperative period. Thromboelastograph (TEG) is a point-of-care test for evaluation of hemostasis, which has been widely used in the field of liver transplantation and coronary bypass surgery as an intraoperative hemostatic monitoring device [5-7]. By measuring the dynamic process of blood coagulation, with defined parameters reflecting integrity of specific hemostatic components, this device can differentiate hypercoagulable state into different types—platelet, enzymatic, and mixed, according to the manufacturer [8
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