Mamczak Christiaan N, Speybroeck Jacob, Stillson John E, Dynako Joseph, Piscoya Andres, Peck Ethan E, Aboukhaled Michael, Cancel Emily, McDonald Michael, Garcia Diego, Lovejoy John, Lubin Stephanie, Stanton Robert, Kutcher Matthew E
Department of Orthopaedic Trauma, Florida Orthopaedic Institute, St. Petersburg, FL 33701, USA.
Department of Orthopaedic Surgery, MetroHealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH 44106, USA.
J Clin Med. 2022 Jul 12;11(14):4029. doi: 10.3390/jcm11144029.
The application of viscoelastic hemostatic assays (VHAs) (e.g., thromboelastography (TEG) and rotational thromboelastometry (ROTEM)) in orthopedics is in its relative infancy when compared with other surgical fields. Fortunately, several recent studies describe the emerging use of VHAs to quickly and reliably analyze the real-time coagulation and fibrinolytic status in both orthopedic trauma and elective orthopedic surgery. Trauma-induced coagulopathy-a spectrum of abnormal coagulation phenotypes including clotting factor depletion, inadequate thrombin generation, platelet dysfunction, and dysregulated fibrinolysis-remains a potentially fatal complication in severely injured and/or hemorrhaging patients whose timely diagnosis and management are aided by the use of VHAs. Furthermore, VHAs are an invaluable compliment to common coagulation tests by facilitating the detection of hypercoagulable states commonly associated with orthopedic injury and postoperative status. The use of VHAs to identify hypercoagulability allows for an accurate venous thromboembolism (VTE) risk assessment and monitoring of VTE prophylaxis. Until now, the data have been insufficient to permit an individualized approach with regard to dosing and duration for VTE thromboprophylaxis. By incorporating VHAs into routine practice, orthopedic surgeons will be better equipped to diagnose and treat the complete spectrum of coagulation abnormalities faced by orthopedic patients. This work serves as an educational primer and up-to-date review of the current literature on the use of VHAs in orthopedic surgery.
与其他外科领域相比，粘弹性止血检测（VHA）（如血栓弹力图（TEG）和旋转血栓弹力测定法（ROTEM））在骨科的应用尚处于相对起步阶段。幸运的是，最近的几项研究描述了VHA在骨科创伤和择期骨科手术中新兴的应用，即快速、可靠地分析实时凝血和纤维蛋白溶解状态。创伤性凝血病——一系列异常凝血表型，包括凝血因子消耗、凝血酶生成不足、血小板功能障碍和纤维蛋白溶解失调——仍然是重伤和/或出血患者潜在的致命并发症，VHA有助于对其进行及时诊断和处理。此外，VHA是对常见凝血检测的宝贵补充，有助于检测通常与骨科损伤和术后状态相关的高凝状态。使用VHA识别高凝状态可进行准确的静脉血栓栓塞（VTE）风险评估和VTE预防监测。到目前为止，关于VTE预防的剂量和持续时间的数据还不足以支持个体化方法。通过将VHA纳入常规实践，骨科医生将更有能力诊断和治疗骨科患者面临的各种凝血异常。本文旨在作为一篇教育性入门文章，并对目前关于VHA在骨科手术中应用的文献进行最新综述。
