Thromboelastography in elective total hip arthroplasty.
Thromboelastography in elective total hip arthroplasty.
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DOI：
10.5312/wjo.v12.i8.555
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发表时间：
2021-08-18
影响因子：
1.9
通讯作者：
Weinberg L
中科院分区：
文献类型：
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作者：
Lloyd-Donald P;Lee WS;Liu GM;Bellomo R;McNicol L;Weinberg L
高凝状态在全髋关节置换术（THA）后易发生静脉血栓栓塞（VTE）的患者中起着重要作用。我们使用血栓弹性描记术（TEG）来检查接受THA的患者的凝血状态。在接受依诺肝素标准VTE化学预防的THA患者中检查通过TEG测量的凝血。 在获得伦理批准后，我们对接受初次择期THA的患者中收集的数据进行了回顾性分析。我们分析了皮肤切开前、术中和术后5天采集的样本的TEG数据。术前和术后第5天进行常规凝血试验。 纳入了20例接受全身麻醉的患者和32例接受脊髓麻醉（SA）的患者。TEG表现为术后进行性高凝状态，其特征为最大振幅升高。TEG还显示接受SA的患者存在一过性术中高凝状态。相比之下，除了术后第5天血浆纤维蛋白原增加外，所有患者术前和术后的常规凝血试验均正常。 尽管静脉血栓栓塞预防，全髋关节置换术后的患者仍然处于高凝状态，通过TEG和常规测试测量。这一组可能受益于更佳的抗凝和/或额外的围手术期止血监测，通过TEG或其他方式。
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. To examine coagulation as measured by TEG in patients undergoing THA who received standard VTE chemoprophylaxis with enoxaparin. 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. 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. 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.