Persistent postoperative hypercoagulability and venous thromboembolism risk following pelvic and acetabular fractures: A prospective pilot study

Background Pelvic and acetabular (PA) fractures are severe orthopaedic injuries associated with high risk of venous thromboembolism (VTE), a potentially life-threatening complication, despite current thromboprophylaxis strategies. The duration of postoperative hypercoagulability and associated VTE risk following surgical fixation remain unknown. Thromboelastography (TEG) analysis can assess the entire clotting process and can be used to quantify hypercoagulability and increased VTE risk through maximal amplitude (MA) and coagulation index (CI) parameters. Purpose To characterize the extent and duration of postoperative hypercoagulability and VTE risk following PA fractures using serial TEG analysis. Methods Adults undergoing surgical management of PA fractures were prospectively enrolled. Serial TEG analysis was performed from admission to 3 months postoperatively. Standardized thromboprophylaxis consisted of low-molecular-weight heparin for 28 days postoperatively. Screening compression ultrasound was performed to detect asymptomatic proximal deep vein thrombosis (DVT) on postoperative day 3 (POD3). Mobility was measured using Timed Up and Go (TUG) test. One-sample t-tests compared mean MA and CI values at each time point with predefined hypercoagulable thresholds (MA ≥65mm, CI >3). Results Thirty patients were enrolled, including 22 men (median age: 52.5 years). Most were hypercoagulable by POD3 and MA peaked on POD7. Hypercoagulability persisted in 75.0% and 38.5% of patients at four and six weeks, respectively. At three months, 28.6% remained hypercoagulable. 23.3% developed VTE (five pulmonary emboli, two proximal DVTs). Patients with acetabular fractures had consistently higher MA values. Conclusion Despite standard thromboprophylaxis, patients with PA fractures demonstrated persistent hypercoagulability and a substantial VTE rate. These findings suggest that thrombosis risk may persist beyond current thromboprophylaxis durations and support further investigation of individualized strategies, particularly following acetabular fractures.