Enhanced diagnostic capabilities of thromboelastography coupled with standard coagulation indices for predicting perioperative thrombosis in older individuals with hip fractures
Authors: Yang Huan , Yuan MD，Yusong , Shi PhD，Lei , Yang MD，Yurun , Zhu Yidan , Chen Ying 
Published: December 2024

Background:
Deep venous thrombosis of the lower extremity is a common and fatal complication of hip fracture in elderly individuals. However, there is a lack of targeted laboratory diagnostic methods. Although traditional laboratory indicators can provide some reference, their diagnostic efficiency is relatively limited. This study aimed to investigate the diagnostic accuracy of thromboelastography (TEG) combined with traditional coagulation parameters for the early diagnosis of newly occurring lower extremity deep vein thrombosis (DVT) in elderly patients with hip fractures.
Methods:
We conducted a retrospective cohort study including seventy-four elderly patients with hip fractures without lower extremity DVT at admission between 2022 and 2023. Disease history and laboratory test results, including routine blood tests, six coagulation parameters at admission, and TEG results on the day after the operation, were collected via validated methods. Color Doppler ultrasonography of the lower extremity vein was performed at admission and discharge to confirm the diagnosis of new perioperative thrombosis. A logistic regression model was used to construct joint diagnostic indices using traditional parameters, including coagulation parameters and patient histories, combined with TEG indicators, and a receiver operating characteristic (ROC) curve was used to evaluate the discriminatory ability of each TEG indicator and joint diagnostic indicator for newly occurring thrombosis in elderly patients with hip fracture.
Results:
The incidence of lower extremity DVT was 33.78%. The average age was 82.0 years, and 7.0% were male. The TEG R values at discharge were 5.8 min and 6.3 min for the DVT and without VTE groups, respectively, indicating a significant difference (p = 0.035). D-dimer levels were significantly higher in the DVT group than in the non-VTE group (4.3 vs. 2.9 mg/L, p = 0.029). The multivariate-adjusted model revealed significant correlations between newly occurring DVT and TEG indicators, including R values, D-dimer, and BMI, with odds ratios of 0.43, 1.43, and 1.25, respectively (all p values < 0.05). Among each traditional coagulation parameter and TEG indicator, D-dimer and the R value had the highest diagnostic accuracy (ROC area under the curve (AUC) for D-dimer: 67.7%; AUC for R: 67.6%). For the joint indicators, the combination of R + CI + αangle + D-dimer had the highest AUC (0.7475), followed by R + CI + αangle + BMI (0.7123). R + CI + αangle + gender had the lowest AUC (0.5920).
Conclusion:
TEG demonstrates diagnostic value for newly occurring lower extremity DVT in elderly hip fracture patients. When traditional coagulation parameters and patient histories are combined, their diagnostic value is further enhanced, providing robust support for the establishment of a more comprehensive diagnostic and predictive scoring system for DVT in elderly hip fracture patients.