Application Of Thrombelastography (TEG) For Evaluation Of Hypercoagulable State In Perioperative Period Of Primary/Revision Total Hip Arthroplasty (THA)

Background: Questions remain, there are no optimal accurately monitoring methods to assess the changes of coagulability during the perioperative period of arthroplasty especially revision THA. The objective of this study is to evaluate the Hypercoagulable State In Perioperative Period Of Primary/Revision THA by using a novel technique—TEG.Methods: A retrospective review was conducted on 333 consecutive patients who underwent primary THA (236) or revision THA (97) and received rivaroxaban anticoagulant therapy at a tertiary academic center. TEG parameters, TEG coagulation status, and incidence of thrombotic events were used for coagulation evaluation.Results: Compared with primary THA, revision THA had consistent statistically significant shortened R times on Pre, POD 1, POD3, POD 5, and POD7(P<0.05) . And the revision THA had consistent statistically significant increased MA than primary THA on Pre, POD 1, POD3, POD 5, and POD7(P<0.05) (Fig.1b). Similarly, compared with primary THA, revision THA had consistent statistically significant increased CI on Pre, POD 1, POD3, POD 5, and POD7(P<0.05) (Fig.1c). Significant differences in the incidence of hypercoagulable status between revision THA and primary THA on POD 1, 3, 5, and 7 ( P<0.05)These results suggested that patients who received revision THA were significantly more likely with hypercoagulable states. The results of the multivariate logistics regression analysis showed that R, MA, CI, operation time, and blood transfusion rate were independent risk factors for patients with postoperative hypercoagulability (P<0.05).Conclusions: Compared with primary THA patients, revision THA patients have a higher incidence of hypercoagulation, which may be related to longer operation time, greater surgical trauma, more intraoperative blood loss, and higher blood transfusion rate. TEG is a sensitive method to detect the evaluation of coagulation in the perioperative period of primary/revision THA. R, MA, and CI were independent risk factors for patients with postoperative hypercoagulability, Which is of great significance for predicting hypercoagulability. In addition, the use of rivaroxaban anticoagulation alone after THA cannot effectively reduce the incidence of postoperative hypercoagulability, especially platelet hypercoagulability and mixed hypercoagulability.