To explore the dynamic changes
of hypercoagulability after primary total hip/knee arthroplasty
(THA/TKA) , and potential risk factors during prophylactic
anti-coagulation therapy for setting up proper perioperative management.
From August 2015 to May 2017, this
prospective study enrolled patients who underwent primary THA/TKA.
Thromboelastogram (TEG) and platelet count were evaluated
preoperatively, at 1, 4 and 7 days postoperatively. Variation trends of
the parameters were analyzed.
Based on the
including and excluding criteria, 100 patients were entered into this
study, including 50 patients who received TKA, while the other 50
patients who had THA. The normal TEG parameters were noted
preoperatively in all of them. Compared with those before operation, the
R value declined to the minimum at 4 days postoperatively, while the K
value kept steady decline until 7 days after surgery, moreover, the peak
of a-angle and MA value increased to the maximum at 7 days
postoperatively, with statistically significant differences (P ＜0.001) .
No differences of reactive hypercoagulability after surgery were found
between the TKA and THA, although significant differences in
hypercoagulability were noted among the time points, including that
preoperatively, at 1, 4 and 7 days postoperatively. According to TEG
monitoring, the hypercoagulability kept rising in the first 7 days
after surgery. The hypercoagulability varied with increased proportion
of the platelet type and the mixed type over time.
With dynamic TEG monitoring during perioperative period, discrepancies of blood coagulation status in different patient at different time point do be revealed. Therefore, monitoring and individualized regulation of anti-coagulation are necessary.