Observational Study
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Aug 18, 2021; 12(8): 555-564
Published online Aug 18, 2021. doi: 10.5312/wjo.v12.i8.555
Thromboelastography in elective total hip arthroplasty
Patryck Lloyd-Donald, Wen-Shen Lee, Guo-Ming Liu, Rinaldo Bellomo, Larry McNicol, Laurence Weinberg
Patryck Lloyd-Donald, Wen-Shen Lee, Guo-Ming Liu, Larry McNicol, Laurence Weinberg, Department of Anesthesia, Austin Health, Heidelberg 3084, Victoria, Australia
Rinaldo Bellomo, Department of Intensive Care, Austin Hospital, Melbourne 3084, Victoria, Australia
Laurence Weinberg, Department of Surgery, The University of Melbourne, Austin Health, Melbourne 3084, Victoria, Australia
Author contributions: McNicol L and Liu GM were the main authors responsible for study design; Patients were primarily recruited, and data collection performed, by Liu GM and McNicol L; This existing data was inherited and analyzed primarily by Lee WS, McNicol L, Lloyd-Donald P and Weinberg L; The bulk of the manuscript was drafted by Lloyd-Donald P, Lee WS, Bellomo R and Weinberg L; all authors read and approved the final manuscript.
Institutional review board statement: The Austin Health Research and Ethics Committee approved this retrospective study (HREC ref number: LNR/19/Austin/21).
Informed consent statement: The informed consent was waived.
Conflict-of-interest statement: The authors declare that they have no competing interests.
Data sharing statement: The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Original data is contained on old Minitab (.mtw) files that have compatibility issues with recent versions.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Laurence Weinberg, BSc, MBChB, MD, MRCP, Associate Professor, Director, Doctor, Staff Physician, Department of Anesthesia, Austin Health, 145 Studley Road, Heidelberg 3084, Victoria, Australia. laurence.weinberg@austin.org.au
Received: February 15, 2021
Peer-review started: February 15, 2021
First decision: May 6, 2021
Revised: May 21, 2021
Accepted: July 9, 2021
Article in press: July 9, 2021
Published online: August 18, 2021
Processing time: 176 Days and 23.5 Hours
Abstract
BACKGROUND

Hypercoagulability plays an important role in predisposing patients to venous thromboembolism (VTE) after total hip arthroplasty (THA). We used thromboelastography (TEG) to examine the coagulation status of patients undergoing THA.

AIM

To examine coagulation as measured by TEG in patients undergoing THA who received standard VTE chemoprophylaxis with enoxaparin.

METHODS

After ethical approval, we performed a retrospective analysis of data collected in patients undergoing primary elective THA. We analyzed TEG data on samples performed before skin incision, intraoperatively and for 5 d postoperatively. Conventional coagulation tests were performed preoperatively and on postoperative day 5.

RESULTS

Twenty patients undergoing general anesthesia and 32 patients undergoing spinal anesthesia (SA) were included. TEG demonstrated a progressively hypercoagulable state postoperatively, characterized by elevated maximum amplitude. TEG also demonstrated transient intraoperative hypercoagulability in patients receiving SA. In contrast, conventional coagulation tests were normal in all patients, pre- and postoperatively, except for an increase in plasma fibrinogen day 5 postoperatively.

CONCLUSION

Despite VTE prophylaxis, patients following total hip replacement remain in a hypercoagulable state as measured by both TEG and conventional tests. This group may benefit from more optimal anticoagulation and/or additional perioperative hemostatic monitoring, via TEG or otherwise.

Keywords: Surgery; Orthopedic; Anesthesia; Hip arthroplasty; Hypercoagulability; Thrombelastography

Core Tip: Patients undergoing total hip arthroplasty are a high-risk cohort for venous thromboembolism postoperatively. Thromboelastography (TEG) is a modality for investigating global coagulation status. There is limited evidence surrounding the use of TEG in this patient group. Our observational study revealed this patient cohort exhibits a progressively hypercoagulable state postoperatively, characterized primarily by elevated TEG maximum amplitude. The clinical significance of this hypercoagulability is yet to be fully elucidated, however suggests further outcome-based studies exploring anti-coagulation therapy in this cohort may be beneficial.