Abstract Number: VPB1380
Meeting: ISTH 2022 Congress
Background: Hip fractures are an epidemic and despite thromboprophylaxis, venous thromboembolism (VTE) rates remain high (2.5-5%). Serial thrombelastography (TEG) analysis can quantify hypercoagulable state and increased VTE risk. Platelet mapping (PLM) can be used to activate platelets at the adenosine diphosphate (ADP) receptor or the Thromboxane A2 (AA) receptor, to evaluate clot strength when platelets are activated through those specific receptors.
Aims: 1) To evaluate platelet contribution to hypercoagulability and 2) to compare hypercoagulability between arthroplasty and fracture fixation surgical treatments.
Methods: Consecutive adult patients undergoing acute hip fracture surgery were enrolled in this prospective cohort study. Exclusion criteria were prior VTE, active malignancy, or pre-injury therapeutic anticoagulation. Following informed or surrogate consent, serial TEG and PLM analyses were performed at admission, post-operative day (POD) 1, 3, 5, 7 and at 2-, 4-, 6- and 12-weeks post-operatively, using the TEG6s hemostasis analyzer (Haemonetics Corporation). All patients received low molecular weight heparin (LMWH) for 28 days post-operatively. Hypercoagulability was defined as maximal amplitude (MA; a measure of clot strength) over 65mm based on TEG analysis. T-tests were used to compare MA values with the hypercoagulability threshold and between arthroplasty and fracture fixation.
Results: Fifty patients were enrolled with a mean age of 78.0 (SD = 11.0) years and 56% being female. Twenty-nine (58%) were treated with arthroplasty. TEG analysis demonstrated hypercoagulability until 12-weeks for over 50% of patients and PLM identified platelet-mediated hypercoagulability based on elevated ADP-MA and AA-MA, with more pronounced platelet contribution demonstrated via the AA pathway (Figure 1). Patients treated with arthroplasty demonstrated a trend towards more pronounced hypercoagulability (Figure 2).
Conclusion(s): This study supports further investigation into the safety and efficacy of prolonged thromboprophylaxis for some patients and the investigation of anti-platelet thromboprophylaxis following hip fracture surgery.
To cite this abstract in AMA style:Schneider P, Dodd A, Duffy P, Martin R, Korley R, Skeith L. Prolonged Platelet-mediated Hypercoagulability Occurs Following Surgically Treated Hip Fractures [abstract]. https://abstracts.isth.org/abstract/prolonged-platelet-mediated-hypercoagulability-occurs-following-surgically-treated-hip-fractures/. Accessed August 16, 2022.
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