Wang Cheng, Liu Qiaohui, Sun Lei, Dai Guofeng
Blood Coagul Fibrinolysis. 2019 Sep;30(6):281-290. doi: 10.1097/MBC.0000000000000839.
: Thrombelastography (TEG) parameters and prothrombin time (PT), activated partial thromboplastin time (APTT) are compared and analysed. According to change of TEG parameters and assessment of haemostatic state of each patient, we try to explore the feasibility of individualized anticoagulant therapies. 87 people with hip or knee diseases awaiting arthroplasty were recruited. Haemoglobin levels and TEG parameters including R, K, α-angle, maximum amplitude, coagulation index were assessed in perioperative period. PT and APTT were assessed preoperatively. For 65 patients with normal TEG parameters, PT and APTT, we use tranexamic acid (TXA) to reduce blood loss during operation. As hypercoagulability group, 12 patients awaiting unilateral total knee arthroplasty with hypercoagulable state assessed by TEG parameters or risks for venous thromboembolism received daily 10-mg rivaroxaban until 24 h preoperatively and did not receive TXA during operation. All patients received intravenous administration of argatroban after 8 h postoperatively until day 3 and oral administration of rivaroxaban (10 mg) subsequently to prevent deep vein thrombosis or/and pulmonary embolism until 35 days postoperatively. TEG parameters have significant relationships with fibrinogen, platelet and APTT. The number of patients with abnormal haemostatic state assessed by TEG parameters is higher than that assessed by PT, APTT. TEG show hypercoagulability develops throughout perioperative period. There was no significant difference in haemoglobin concentration between hypercoagulability group and normal group in patients receiving unilateral total knee arthroplasty. TEG have higher sensitivity of perioperative abnormal haemostatic state than PT, APTT in primary arthroplasty. For patients with hypercoagulability, individualized anticoagulant therapies such as preoperative administration of rivaroxaban and not using TXA in operation is safe and effective.
对血栓弹力图（TEG）参数与凝血酶原时间（PT）、活化部分凝血活酶时间（APTT）进行比较和分析。根据TEG参数的变化及对每位患者止血状态的评估，我们试图探索个体化抗凝治疗的可行性。招募了87例等待关节置换术的髋部或膝部疾病患者。在围手术期评估血红蛋白水平以及包括R、K、α角、最大振幅、凝血指数在内的TEG参数。术前评估PT和APTT。对于65例TEG参数、PT和APTT正常的患者，我们使用氨甲环酸（TXA）以减少手术期间的失血。作为高凝组，12例等待单侧全膝关节置换术且经TEG参数评估为高凝状态或有静脉血栓栓塞风险的患者，术前每日服用10毫克利伐沙班直至术前24小时，手术期间不服用TXA。所有患者术后8小时后静脉注射阿加曲班直至第3天，随后口服利伐沙班（10毫克）以预防深静脉血栓形成或/和肺栓塞直至术后35天。TEG参数与纤维蛋白原、血小板和APTT有显著关系。通过TEG参数评估的止血状态异常患者数量高于通过PT、APTT评估的患者数量。TEG显示围手术期全程均出现高凝状态。接受单侧全膝关节置换术的患者中，高凝组与正常组的血红蛋白浓度无显著差异。在初次关节置换术中，TEG对围手术期异常止血状态的敏感性高于PT、APTT。对于高凝患者，术前服用利伐沙班及手术中不使用TXA等个体化抗凝治疗是安全有效的。
