Studying Hypercoagulability in Hip Fracture Patients as Determined by Thrombelastography
Date
2020-06-29
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
Abstract
Hip fractures are the most devastating manifestation of osteoporosis with high venous thromboembolic (VTE) rates reported following surgery. Currently, there is no guideline consensus on the optimal duration of pharmacologic thromboprophylaxis or medication choice. Furthermore, some patients develop VTE despite being on anticoagulation. Thrombelastography (TEG) is a whole-blood viscoelastic hemostatic assay that has the potential to identify hypercoagulable patients at risk for developing VTE. The purpose of this study was to understand the utility of TEG analysis to quantify hypercoagulability and ensuing VTE risk in patients with hip fracture. Serial TEG analysis was performed in a cohort of patients with hip fracture every 24-hours from admission until post-operative day (POD) five, then at two and six weeks post-operatively. Hypercoagulability was quantified using a TEG maximal amplitude (MA) threshold over 65 mm. Multivariable logistic regression evaluated associations between elevated MA values and patient and surgical factors. In total, 121 patients (88 female) with a median age of 81 (range = 53 – 96) were recruited. Although admission TEG analysis revealed normal coagulation status (MA<65mm), patients transitioned to a hypercoagulable state by POD 3. Hypercoagulability peaked two weeks post-operatively. Furthermore, most patients remained hypercoagulable six weeks post-operatively, despite discontinuing anticoagulation one to two weeks prior. On admission, female sex and the presence of chronic kidney disease were associated with hypercoagulability (MA>65mm). Post-operatively, reduced mobility and treatment with arthroplasty were associated with hypercoagulability (MA>65mm). Results from this study support further investigation into individualized extended thromboprophylaxis regimens in patients with hip fracture. Additionally, TEG-identified patient and surgical factors associated with hypercoagulability should be given further consideration to mitigate VTE risk and in the development of future hip fracture specific VTE risk prediction models.
Description
Keywords
Hip fracture, Thrombelastography, Hypercoagulability, Venous Thromboembolism, Thromboprophylaxis, Precision Medicine
Citation
You, D. Z. (2020). Studying Hypercoagulability in Hip Fracture Patients as Determined by Thrombelastography (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.