Studying Hypercoagulability in Hip Fracture Patients as Determined by Thrombelastography

You, Daniel Zheng

Studying Hypercoagulability in Hip Fracture Patients as Determined by Thrombelastography

dc.contributor.advisor	Schneider, Prism Steorra
dc.contributor.advisor	Salo, Paul T.
dc.contributor.author	You, Daniel Zheng
dc.contributor.committeemember	Fritzler, Marvin J.
dc.contributor.committeemember	Korley, Robert E. C.
dc.contributor.committeemember	Skeith, Leslie
dc.date.accessioned	2020-07-06T13:52:10Z
dc.date.available	2020-07-06T13:52:10Z
dc.date.issued	2020-06-29
dc.description.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.	en_US
dc.identifier.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.	en_US
dc.identifier.doi	http://dx.doi.org/10.11575/PRISM/37972
dc.identifier.uri	http://hdl.handle.net/1880/112250
dc.language.iso	eng	en_US
dc.publisher.faculty	Cumming School of Medicine	en_US
dc.publisher.institution	University of Calgary	en
dc.rights	University of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.	en_US
dc.subject	Hip fracture	en_US
dc.subject	Thrombelastography	en_US
dc.subject	Hypercoagulability	en_US
dc.subject	Venous Thromboembolism	en_US
dc.subject	Thromboprophylaxis	en_US
dc.subject	Precision Medicine	en_US
dc.subject.classification	Medicine and Surgery	en_US
dc.title	Studying Hypercoagulability in Hip Fracture Patients as Determined by Thrombelastography	en_US
dc.type	master thesis	en_US
thesis.degree.discipline	Medicine – Medical Sciences	en_US
thesis.degree.grantor	University of Calgary	en_US
thesis.degree.name	Master of Science (MSc)	en_US
ucalgary.item.requestcopy	true	en_US