Thromboelastography for the Orthopaedic Surgeon

John C. Hagedorn II, MD; James M. Bardes, MD; Creed L. Paris, MD; Ronald W. Lindsey, MD, FACS

Disclosures

J Am Acad Orthop Surg. 2019;27(14):503-508. 

In This Article

Current Thromboelastography Research in Orthopaedics

Although TEG research in orthopaedic surgery is limited compared with other fields of medicine, it has been studied in orthopaedic trauma, hip and knee arthroplasty, and scoliosis. TEG was shown to be predictive of VTE in patients with severe extremity trauma; specifically, TEG MA ≥ 65 and MA ≥ 72 on presentation were independent risk factors for deep vein thrombosis and pulmonary embolism, respectively.[28]

The use of TEG in the management of traumatic hemorrhage secondary to pelvic fractures has also demonstrated early promise. Mamczak et al[36] reported that when they used TEG to direct patient-centered blood product use, patients with pelvic fractures often fell outside the standard 1:1:1 transfusion ratio (PRBC:FFP:Platelet) to achieve resolution of trauma-induced coagulopathy. These findings were consistent with other similar studies in the general surgery trauma literature, suggesting that the 1:1:1 transfusion ratio might not be appropriate for all patients.[4,16,18–20] Finally, Liu et al[37] found that compared with control subjects fracture patients older than 60 years were hypercoagulable on TEG, and they proposed that fractures in the elderly induce a hypercoagulable state that may benefit from being preemptively addressed to minimize the risk for VTE.

The role of TEG in the elective orthopaedic setting has also been explored. In one study, the use of TEG revealed that 37.8% of total knee and total hip patients evaluated remained in a hypercoagulable state 10 days postoperatively and that 76.5% of these patients had a hypercoagulable state because of platelet abnormalities or mixed causes.[38] Bosch et al[39] demonstrated that the coagulation profile of a patient undergoing posterior spinal fusion for scoliosis had stable clotting factors (PT/PTT) and platelets throughout the case and that fibrinolysis was the major cause for bleeding. A more recent study by Ohrt-Nissen et al[40] established that perioperative transfusion planning that included TEG contributed to a reduction in the amount of PRBCs transfused and allowed for more suitable patient-centered transfusion in posterior spinal fusion for scoliosis.

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