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. 2016 Oct-Dec;7(Suppl 2):225-229.
doi: 10.1016/j.jcot.2016.08.003. Epub 2016 Aug 24.

Is pre-operative assessment of coagulation profile with Thrombelastography (TEG) useful in predicting venous thromboembolism (VTE) following orthopaedic surgery?

Apurve Parameswaran  1 , Vignesh P Krishnamoorthy  1 , Anil T Oommen  1 , Anita Jasper  2 , Ravi J Korula  1 , Sukesh C Nair  3 , Pradeep M Poonnoose  1
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Is pre-operative assessment of coagulation profile with Thrombelastography (TEG) useful in predicting venous thromboembolism (VTE) following orthopaedic surgery?

Apurve Parameswaran et al. J Clin Orthop Trauma. 2016 Oct-Dec.

Abstract

Introduction: Epidemiologic data on the incidence of venous thromboembolism (VTE) in Indian population vary widely. Most studies show that the incidence of VTE is lower in Asian patients than in Western population. Screening tools to identify high-risk patients should enable us to reduce this complication.

Methods: The incidence of VTE in 101 patients who underwent knee or hip arthroplasty, or surgery for hip fractures, without chemoprophylaxis for deep vein thrombosis (DVT) was documented. Diagnosis of DVT was made with Duplex ultrasonography. We also assessed the usefulness of pre-operative assessment of the hypercoagulable status of the patient in predicting the occurrence of VTE, using the Thrombelastography (TEG) test.

Results: The incidence of DVT in the study population was 7%. Six of the 7 patients who developed DVT had surgery for hip fractures, while one had knee replacement. The thrombus was above the knee joint level in 6 of the 7 patients. Pre-operative TEG was positive in only one of the 7 patients, but was positive in 37 of the remaining 94 patients.

Conclusion: Incidence of DVT in the study population is sufficiently high to recommend some form of prophylaxis to prevent VTE following hip and knee surgery. Pre-operative assessment of the patients' coagulation status with Thrombelastography does not predict the risk of VTE. The use of other lab parameters that could help in selective chemoprophylaxis needs to be explored.

Keywords: Deep vein thrombosis; Incidence; Orthopaedic surgery; Thrombelastography; Venous thromboembolism.

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Figures

Fig. 1
Fig. 1
Normal TEG curve. R, time taken for clot formation to begin; K, time period between initiation of clot formation and the time when an amplitude of 20 mm is attained; α angle, angle subtended on the graph by the tangent drawn to the curve starting from the initiation of coagulation, over the baseline; MA, maximum amplitude (highest amplitude) attained on the curve.
Fig. 2
Fig. 2
TEG curves generated in the test. (a) Example of a normal TEG curve. (b) Example of a hypercoagulable state.
See this image and copyright information in PMC

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