title: Is pre-operative assessment of coagulation profile with Thrombelastography (TEG) useful in predicting venous thromboembolism (VTE) following orthopaedic surgery?
abstract: BACKGROUND
  Epidemiologic data on the incidence of venous thromboembolism (VTE) in Indian population vary widely. Most studies show that the incidence of VTE is lower in Asian patients than in Western population. Screening tools to identify high-risk patients should enable us to reduce this complication.
  
  
  METHODS
  The incidence of VTE in 101 patients who underwent knee or hip arthroplasty, or surgery for hip fractures, without chemoprophylaxis for deep vein thrombosis (DVT) was documented. Diagnosis of DVT was made with Duplex ultrasonography. We also assessed the usefulness of pre-operative assessment of the hypercoagulable status of the patient in predicting the occurrence of VTE, using the Thrombelastography (TEG) test.
  
  
  RESULTS
  The incidence of DVT in the study population was 7%. Six of the 7 patients who developed DVT had surgery for hip fractures, while one had knee replacement. The thrombus was above the knee joint level in 6 of the 7 patients. Pre-operative TEG was positive in only one of the 7 patients, but was positive in 37 of the remaining 94 patients.
  
  
  CONCLUSIONS
  Incidence of DVT in the study population is sufficiently high to recommend some form of prophylaxis to prevent VTE following hip and knee surgery. Pre-operative assessment of the patients' coagulation status with Thrombelastography does not predict the risk of VTE. The use of other lab parameters that could help in selective chemoprophylaxis needs to be explored.
authors.affiliation: Department of Orthopaedics-Unit II, Christian Medical College, Vellore 632004, Tamil Nadu, India.
authors.forename: Apurve
authors.initials: A
authors.lastname: Parameswaran
authors.affiliation: Department of Orthopaedics-Unit II, Christian Medical College, Vellore 632004, Tamil Nadu, India.
authors.forename: Vignesh P
authors.initials: VP
authors.lastname: Krishnamoorthy
authors.affiliation: Department of Orthopaedics-Unit II, Christian Medical College, Vellore 632004, Tamil Nadu, India.
authors.forename: Anil T
authors.initials: AT
authors.lastname: Oommen
authors.affiliation: Department of Radiology, Christian Medical College, Vellore 632004, Tamil Nadu, India.
authors.forename: Anita
authors.initials: A
authors.lastname: Jasper
authors.affiliation: Department of Orthopaedics-Unit II, Christian Medical College, Vellore 632004, Tamil Nadu, India.
authors.forename: Ravi J
authors.initials: RJ
authors.lastname: Korula
authors.affiliation: Department of Transfusion Medicine and Immunohaematology, Christian Medical College, Vellore 632004, Tamil Nadu, India.
authors.forename: Sukesh C
authors.initials: SC
authors.lastname: Nair
authors.affiliation: Department of Orthopaedics-Unit II, Christian Medical College, Vellore 632004, Tamil Nadu, India.
authors.forename: Pradeep M
authors.initials: PM
authors.lastname: Poonnoose
keywords: Deep vein thrombosis; Incidence; Orthopaedic surgery; Thrombelastography; Venous thromboembolism