Studying Hypercoagulability in Hip Fracture Patients as Determined by Thrombelastography

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dc.contributor.advisorSchneider, Prism Steorra
dc.contributor.advisorSalo, Paul T.
dc.contributor.authorYou, Daniel Zheng
dc.contributor.committeememberFritzler, Marvin J.
dc.contributor.committeememberKorley, Robert E. C.
dc.contributor.committeememberSkeith, Leslie
dc.date.accessioned2020-07-06T13:52:10Z
dc.date.available2020-07-06T13:52:10Z
dc.date.issued2020-06-29
dc.description.abstractHip fractures are the most devastating manifestation of osteoporosis with high venous thromboembolic (VTE) rates reported following surgery. Currently, there is no guideline consensus on the optimal duration of pharmacologic thromboprophylaxis or medication choice. Furthermore, some patients develop VTE despite being on anticoagulation. Thrombelastography (TEG) is a whole-blood viscoelastic hemostatic assay that has the potential to identify hypercoagulable patients at risk for developing VTE. The purpose of this study was to understand the utility of TEG analysis to quantify hypercoagulability and ensuing VTE risk in patients with hip fracture. Serial TEG analysis was performed in a cohort of patients with hip fracture every 24-hours from admission until post-operative day (POD) five, then at two and six weeks post-operatively. Hypercoagulability was quantified using a TEG maximal amplitude (MA) threshold over 65 mm. Multivariable logistic regression evaluated associations between elevated MA values and patient and surgical factors. In total, 121 patients (88 female) with a median age of 81 (range = 53 – 96) were recruited. Although admission TEG analysis revealed normal coagulation status (MA<65mm), patients transitioned to a hypercoagulable state by POD 3. Hypercoagulability peaked two weeks post-operatively. Furthermore, most patients remained hypercoagulable six weeks post-operatively, despite discontinuing anticoagulation one to two weeks prior. On admission, female sex and the presence of chronic kidney disease were associated with hypercoagulability (MA>65mm). Post-operatively, reduced mobility and treatment with arthroplasty were associated with hypercoagulability (MA>65mm). Results from this study support further investigation into individualized extended thromboprophylaxis regimens in patients with hip fracture. Additionally, TEG-identified patient and surgical factors associated with hypercoagulability should be given further consideration to mitigate VTE risk and in the development of future hip fracture specific VTE risk prediction models.en_US
dc.identifier.citationYou, D. Z. (2020). Studying Hypercoagulability in Hip Fracture Patients as Determined by Thrombelastography (Master's thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca.en_US
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/37972
dc.identifier.urihttp://hdl.handle.net/1880/112250
dc.language.isoengen_US
dc.publisher.facultyCumming School of Medicineen_US
dc.publisher.institutionUniversity of Calgaryen
dc.rightsUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.en_US
dc.subjectHip fractureen_US
dc.subjectThrombelastographyen_US
dc.subjectHypercoagulabilityen_US
dc.subjectVenous Thromboembolismen_US
dc.subjectThromboprophylaxisen_US
dc.subjectPrecision Medicineen_US
dc.subject.classificationMedicine and Surgeryen_US
dc.titleStudying Hypercoagulability in Hip Fracture Patients as Determined by Thrombelastographyen_US
dc.typemaster thesisen_US
thesis.degree.disciplineMedicine – Medical Sciencesen_US
thesis.degree.grantorUniversity of Calgaryen_US
thesis.degree.nameMaster of Science (MSc)en_US
ucalgary.item.requestcopytrueen_US
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