156
· DOS Abstracts
Hip fractures: Can Thrombelastography (TEG) on
admission predict overall blood loss
Peter Toft Tengberg, Henrik Palm, Nicolai Foss, Jakob Stensballe,
Thomas Kallemose, Anders Troelsen
CORH, Hvidovre Hospital; Anesthesiologic dept, Hvidovre Hospital; the blood
bank, Rigshospitalet
Background:
Blood loss increases mortality and morbidity following major or-
thopedic surgery, particularly among the frail hip fracture patients. The ability to
predict patients at risk of a large blood loss could be a valuable tool to optimize
care pathways. Thrombelastography (TEG) is used routinely to monitor hemo-
stasis in patients with massive bleeding, in order to guide and reduce transfu-
sion requirements. The advantage of TEG over conventional coagulation tests is
that is measures real time clot formation reflecting the multifactorial causes for
hemostasis deficits.
Purpose / Aim of Study:
To test the viability of TEG as a routine blood sample,
taken on admission, in hip fracture patients, with the purpose of identifying
patients at risk of large blood losses.
Materials and Methods:
The study was a prospective observational study.
TEG results were blinded. From December 2013 to April 2014 all patients ad-
mitted with a hip fracture were subjected to TEG analysis on admission. Of the
227 consecutively admitted and operated patients, 180 completed a full data
collection and were included into the study.
Findings / Results:
Mean overall blood loss, calculated as decrease in hemo-
globin from admission to the fourth-postoperative day, was 1679 ml (1114). A
linear regression model for prediction of blood loss was constructed. The model
included several interactions between the four TEG variables (R, K, angle and
MA), with a significant effect (both p < 0.03). The effect of the inclusion of the
individual TEG variables in the model was tested and found no significant effect
for any one of them (all p > 0.09).
Conclusions:
There are several factors that determine the overall blood loss.
Coagulation status on admission, as measured by TEG, is only one of them. TEG
may very well have a role in guiding transfusion therapy for hip fracture pa-
tients
103.
