McCrath Douglas J, Cerboni Elisabetta, Frumento Robert J, Hirsh Andrew L, Bennett-Guerrero Elliott
Department of Anesthesiology, Columbia University College of Physicians & Surgeons, New York, New York.
Anesth Analg. 2005 Jun;100(6):1576-1583. doi: 10.1213/01.ANE.0000155290.86795.12.
Postoperative thrombotic complications increase hospital length of stay and health care costs. Given the potential for thrombotic complications to result from hypercoagulable states, we sought to determine whether postoperative blood analysis using thromboelastography could predict the occurrence of thrombotic complications, including myocardial infarction (MI). We prospectively enrolled 240 patients undergoing a wide variety of surgical procedures. A cardiac risk score was assigned to each patient using the established revised Goldman risk index. Thromboelastography was performed immediately after surgery and maximum amplitude (MA), representing clot strength, was determined. Postoperative thrombotic complications requiring confirmation by a diagnostic test were assessed by a blinded observer. Ten patients (4.2%) suffered a total of 12 postoperative thrombotic complications. The incidence of thrombotic complications with increased MA (8 of 95 = 8.4%) was significantly (P = 0.0157) more frequent than that of patients with MA < or =68 (2 of 145 = 1.4%). Furthermore, the percentage suffering postoperative MI in the increased MA group (6 of 95 = 6.3%) was significantly larger than that in the MA < or =68 group (0 of 145 = 0%) (P = 0.0035). In a multivariate analysis, increased MA (P = 0.013; odds ratio, 1.16; 95% confidence interval, 1.03-1.20) and Goldman risk score (P = 0.046; odds ratio, 2.39; 95% confidence interval, 1.02-5.61) both independently predicted postoperative MI. A postoperative hypercoagulable state as determined by thromboelastography is associated with postoperative thrombotic complications, including MI, in a diverse group of surgical patients.
术后血栓形成并发症会延长住院时间并增加医疗费用。鉴于高凝状态可能导致血栓形成并发症，我们试图确定使用血栓弹力图进行术后血液分析是否能够预测包括心肌梗死（MI）在内的血栓形成并发症的发生。我们前瞻性地纳入了240例接受各种外科手术的患者。使用既定的修订版戈德曼风险指数为每位患者分配心脏风险评分。术后立即进行血栓弹力图检查，并测定代表血凝块强度的最大振幅（MA）。由一名不知情的观察者评估需要通过诊断测试确认的术后血栓形成并发症。10名患者（4.2%）共发生12例术后血栓形成并发症。MA升高的患者发生血栓形成并发症的发生率（95例中有8例，占8.4%）显著高于MA≤68的患者（145例中有2例，占1.4%）（P = 0.0157）。此外，MA升高组术后发生MI的百分比（95例中有6例，占6.3%）显著高于MA≤68组（145例中有0例，占0%）（P = 0.0035）。在多变量分析中，MA升高（P = 0.013；比值比，1.16；95%置信区间，1.03 - 1.20）和戈德曼风险评分（P = 0.046；比值比，2.39；95%置信区间，1.02 - 5.61）均独立预测术后MI。在不同类型的外科手术患者中，通过血栓弹力图确定的术后高凝状态与包括MI在内的术后血栓形成并发症相关。
