Perioperative Value Of R-TEG Monitoring In Patients Undergoing Arthroplasty

Objectives：Venous thromboembolic disease is the most common complicationafter arthroplasty, which can occur in up to84%of cases following totaljoint replacement. Although there has been validated anticoagulanttherapy, it is still a clinical challenge for surgeons to balance the risk ofhaemorrhagic complication against the risk of thromboembolism in thecontext of invasive surgery. Therefore it is of great importance to find amore rapid, accurate and comprehensive method to monitor the patients’coagulation function. Rapid thromboelastography can provideinformation about the viscoelasticity of the whole blood more accuratelyand comprehensively than conventional coagulation test does. What’smore, it can differentiate the hypercoagulable state into different types,thus providing a basis for the choice of anticoagulant therapy as well asthe length of the therapy. The research aims at monitoring changes ofblood coagulation after thromboprophylaxis for elective arthroplastypatients with r-TEG, and giving advice to anticoagulant therapy. Methods:We selected patients undergoing total joint replacement in departmentof orthopedics, Peking Union Medical College Hospital. The inclusioncriteria were age more than14, ASA grade Ⅰ or Ⅱ, normalpreoperative coagulation function, liver function and renal function, nohistory of using preoperative coagulation-related drugs, and agree to takepart in the research. We recorded in detail the patients’ basic information,general circumstances. Whole blood cell analysis, conventionalcoagulation test, thromboelastography were performed before operation,on the end point of the operation, and on the postoperative days includingthe1st,3rdand the day before discharge. IBM SPSS20was used forstatistical analysis.Results:The parameters of TEG before operation were chosen as baseline value;1.The results of TEG performed on the end of the operation werestatistically different form the baseline value;2.Significant change in theK, α-angle, MA was observed on day3and discharge after operation,which is consistent with the results of CCT;3. Patients were found withhypercoagulable states on day3and on discharge day despite theadministration of anticoagulant therapy;4. The hypercoagulable state hasan increasing trend during the postoperative days.Conclusion:1.Patients undergoing total joint replacement were found with hypocoagulable state on day1after the operaion, it may increase the riskof heamorrhagic complication to add anticoagulation therapy at this time;2. With thromboprophylaxis therapy, patients were still found withhypercoagulable state on day3after operation, additionally thehypercoagulable state had an increasing trend during the postoperativeperiod, which indicates prophylaxis failure and high risk ofthromboembolism;3. Patients were found with hyperfunction of platelets,therefore the prevention of thromboembolism may not be achieved onlyby the utilization of anti-coagulants therapy, and the antiplatelet drug isnecessary.