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Thromboelastography for the Orthopaedic Surgeon

Hagedorn, John C. II MD; Bardes, James M. MD; Paris, Creed L. MD; Lindsey, Ronald W. MD, FACS

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: July 15, 2019 - Volume 27 - Issue 14 - p 503–508
doi: 10.5435/JAAOS-D-17-00603
Review Article

Evaluation of coagulation is vital in the care of the orthopaedic patients, particularly in the subspecialties of trauma, spine, arthroplasty, and revision surgery resulting from blood loss and coagulopathies. Although conventional tests (prothrombin time/international normalized ratio, activated partial thromboplastin time, platelet count, and fibrinogen) are most commonly used, others like thromboelastography (TEG) are also available to the orthopaedic surgeons. TEG is a blood test developed in the 1950s, which provides a snapshot of a patient's coagulation profile by evaluating clot formation and lysis. Recently, TEG has been used to assess traumatic coagulopathy. The coagulation parameters measured by the TEG are reaction time (R-time), time to reach a certain clot strength (K-value), speed of fibrin build up (α-angle), maximum clot amplitude, and percentage decrease of clot in 30 minutes (LY30). Using these values, traumatologists have developed a better, faster, and more accurate overview of a patient's resuscitation and more successfully direct blood product use. However, many orthopaedic surgeons—despite performing surgical procedures that risk notable blood loss and postoperative clotting complications—are unaware of the existence of the TEG blood test and the critical information it provides. Increasing awareness of the TEG among orthopaedic surgeons could have a notable effect on numerous aspects of musculoskeletal care.

From the Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch Galveston, Galveston, TX (Dr. Hagedorn, Dr. Paris, and Dr. Lindsey), and the Division of Acute Care Surgery LAC + USC Medical Center, University of Southern California, Los Angeles, CA (Dr. Bardes).

Dr. Hagedorn or an immediate family member is an employee of and has stock or stock options held in Abbott. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Bardes, Dr. Paris, and Dr. Lindsey.

© 2019 by American Academy of Orthopaedic Surgeons
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