Association of thromboelastogram hypercoagulability with postoperative deep venous thrombosis of the lower extremity in patients with femur and pelvic fractures: a cohort study

Background The relationship between thromboelastogram (TEG) hypercoagulation status and perioperative deep vein thrombosis (DVT) in patients with femoral and pelvic fractures is not well understood. We aimed to investigate the relationship between hypercoagulation status identified by thromboelastography and postoperative DVT formation in patients with femoral and pelvic fractures, as well as to evaluate the role of thromboelastography in assessing hypercoagulation status and predicting postoperative DVT formation. Methods Data from 2,065 patients with femoral and pelvic fractures who underwent surgical treatment at a hospital in China between May 2018 and December 2023 were retrospectively analysed. Hypercoagulable TEG was defined as reaction time (R) < 5 min, coagulation time (K) < 1 min, alpha angle ([alpha]) > 72 degrees, maximum amplitude (MA) > 70 mm, and/or coagulation index (CI) > 3. The correlation between preoperative hypercoagulability identified by TEG and postoperative DVT formation was assessed using multivariate logistic regression. Propensity score matching (PSM) was performed to control for confounding factors. Results Compared to the non-DVT group, the DVT group had decreased R and K values, while the [alpha], MA, and CI values significantly increased (P < 0.05). Multivariate logistic regression analysis demonstrated that hypercoagulable TEG findings were predictive of postoperative DVT formation. PSM, using a 0.1 calliper value, matched 296 patients from the hypercoagulation and non-hypercoagulation groups in a 1:1 ratio. Before PSM, hypercoagulable TEG was associated with DVT in femoral and pelvic fractures (P < 0.001, odds ratio [OR]:1.860, 95% confidence interval: 1.389-2.492). After PSM, these two variables remained correlated (P = 0.001, OR = 1.878, 95% confidence interval:1.301 - 2.709). Conclusions The hypercoagulable state identified by TEG can predict thromboembolic events in patients with femoral and pelvic fractures. Trial registration The study was registered in the Chinese Clinical Trial Register ( Keywords: Fracture, Deep vein thrombosis, Thromboelastography, Propensity score matching