Enhanced diagnostic capabilities of thromboelastography coupled with standard coagulation indices for predicting perioperative thrombosis in older individuals with hip fractures

Enhanced diagnostic capabilities of thromboelastography coupled with standard coagulation indices for predicting perioperative thrombosis in older individuals with hip fractures | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Enhanced diagnostic capabilities of thromboelastography coupled with standard coagulation indices for predicting perioperative thrombosis in older individuals with hip fractures Huan Yang, MD，Yusong Yuan, PhD，Lei Shi, MD，Yurun Yang, Yidan Zhu, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5198509/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 24 Dec, 2024 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted 7 You are reading this latest preprint version Abstract 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. Hip fracture elderly patients TEG DVT combination Figures Figure 1 Figure 2 Figure 3 Introduction Elderly hip fractures refer to fractures of the femoral neck and intertrochanteric and subtrochanteric regions caused by low-energy trauma in individuals aged 60 and older 1 . Hip fractures account for 18.2% of all fractures, and with the increasing aging population in China, the incidence of hip fractures continues to rise 2 . It is projected that by the year 2050, the annual number of elderly patients with hip fractures will reach 6.3 million 3 . Deep vein thrombosis (DVT) in the lower extremities is one of the most common complications in patients with hip fractures. Following injury, immobilization of the affected limb leads to reduced blood flow velocity, and tissue damage activates the immune‒inflammatory system, resulting in hypercoagulability. This cascade of events ultimately contributes to the formation of DVTs in the lower extremities 4 , 5 . Approximately 75% of all cases of deep vein thrombosis are asymptomatic 6 . Studies on the Chinese population indicate a high incidence of lower extremity DVT in elderly hip fracture patients, estimated at approximately 29.8% 7 . Even with the preoperative administration of low-molecular-weight heparin, the occurrence rate of lower extremity DVT in hip fracture patients remains at 3.4% 8 . Additionally, 20.1% of elderly hip fracture patients are reported to have DVT upon admission 9 . Elderly patients with hip fractures, once afflicted with lower extremity deep vein thrombosis (DVT), face numerous adverse outcomes, yet effective laboratory predictive and diagnostic methods are lacking. A prospective study revealed that hip fracture patients with concurrent lower extremity DVT had an average surgical delay of 5.7 days, whereas those without lower extremity DVT had an average delay of 3.2 days 10 . In individuals aged 65 years and above, the mortality rate within 30 days for DVT patients reaches 11%, increasing to 31% within one year 11 . While trauma patients with fractures and concomitant deep vein thrombosis have garnered considerable attention, several studies indicate that traditional coagulation tests lack comprehensive objectivity in assessing coagulation function, particularly in the absence of personalized laboratory diagnostic and predictive criteria for perioperative thrombosis in elderly hip fracture patients. Thromboelastography (TEG) is an emerging laboratory testing method for evaluating coagulation status. TEG dynamically assesses the entire coagulation process, providing qualitative and quantitative indicators of clot formation by evaluating the status of coagulation, platelet aggregation, and fibrinolysis 12 . The key TEG parameters include the reaction time (R), which is the time from the initiation of the first fibrin strand and represents the functionality of the quantity and coagulation factors; coagulation time (K), which is the time from the initiation of fibrin formation until clot formation, predominantly assessing coagulation factors, platelets, and fibrinogen; α-angle (α), which reflects the speed of clot formation, with higher values indicating rapid clot formation and lower values indicating delayed and compromised formation of maximum clot strength; and maximum amplitude (MA), which is the maximum strength of the clot and is dependent on the quantity and interaction of fibrinogen and platelets. An increase in MA suggests a hypercoagulable state or impaired platelet function 13 . Given that thromboelastography (TEG) has been firmly established as a diagnostic marker for thrombotic disorders, such as DIC, the potential utility of TEG in predicting thrombotic events among hospitalized hip fracture patients is unclear. Accordingly, the principal aim of this study was to assess the diagnostic accuracy of TEG, when used in conjunction with standard coagulation markers, for the prompt recognition of incident lower extremity deep vein thrombosis (DVT) in elderly patients with hip fractures. The secondary objective is to identify early thrombotic disorders rather than relying solely on ultrasound devices to confirm the presence of thrombosis. This study established a perioperative thrombosis cohort of elderly hip fracture patients, with lower extremity venous ultrasound results as the gold standard. This study explores the diagnostic and predictive value of individual TEG parameters, combinations of TEG parameters, and the integration of TEG parameters with traditional coagulation indicators, such as six indices of coagulation, a classic coagulation function test project in China involving prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, prothrombin time activity (PTA), international normalized ratio (INR), fibrinogen (Fib), etc., for the prevention and treatment of lower extremity venous thrombosis in elderly hip fracture patients, with the aim of providing robust data support and reference for the prevention and treatment of lower extremity venous thrombosis in these patients. Methods Study population This retrospective study was conducted on patients admitted to the China-Japan Friendship Hospital. All patients with hip fractures between November 1, 2022, and October 31, 2023, were screened for eligibility. The inclusion criteria were as follows: 1) had a femoral neck fracture, intertrochanteric fracture, or subtrochanteric fracture; 2) were aged greater than or equal to 65 years; 3) had undergone internal fixation or joint prosthesis replacement surgery; and 4) had a postoperative hospital stay of more than 3 days. The exclusion criteria for patients were as follows: 1) incomplete medical records; 2) diagnosed with deep venous thrombosis of the lower extremity at admission by ultrasound; 3) suffering from blood system diseases; 4) received anticoagulant therapy before the injury, except for single antiplatelet drugs; 5) severe liver or kidney dysfunction: transaminase > 80 U /L, blood creatinine > 178 µmol/L; 6) severe infectious diseases; and 7) suffering from malignant tumors. Perioperative anticoagulation management All patients received anticoagulant therapy during hospitalization, including health education, graduated compression stockings, and low-molecular-weight heparin (LMWH). Patients who were receiving anticoagulation medications before surgery continued their medications after 30 days of LMWH treatment. The LMWH dose was adjusted for patients with renal insufficiency and a glomerular filtration rate (GFR) < 20 mL/min (2500 IUs for patients 30–50 kg, 3500 IUs for patients 50–150 kg, and 50 IUs/kg for patients 150 kg) 14 . Data collection TEG Test Methods At the time of admission and discharge, the patient's blood routine, TEG, six-item coagulation, and lower extremity venous color Doppler ultrasound were performed. On the first day after the operation, routine blood tests, TEG, and coagulation tests were performed. Patient demographic information was collected at the time of admission. The indices of the TEG included the kinetics time (K), reaction time (R), maximum amplitude (MA), kinetics of plot development (α angle), and complex index (CI) value. The six indices of coagulation include PT, APTT, and D-dimer. The index of routine blood tests is the PLT. Whole-blood TEG was performed with a TEG 6 s hemostasis analyzer (Hemonetics). Patient blood was collected in 2.7 mL tubes containing 3.2% buffered sodium citrate solution and transported to the orthopedic trauma research laboratory. Approximately 0.4 mL of whole blood was manually pipetted into the TEG 6 s cartridge entry port for analysis. All tests were performed within 4 hours of blood collection, as recommended by the manufacturer. The members of our orthopedic trauma research team were trained in using the TEG 6 s system and performed all tests 15 . Statistical analysis Continuous variables are presented as the means ± standard deviations (SDs) or medians (lower and upper quartiles), and categorical variables are presented as numbers and percentages. Characteristics were compared between groups with and without newly occurring DVT via t tests, Wilcoxon rank sum tests, χ2 tests, or Fisher’s exact tests. The simple correlations between each coagulation parameter, including TEG, PT, APTT, D-dimer, PLT, and lower extremity venous thrombosis, were examined via Wilcoxon rank sum tests. Multivariate logistic regression analysis was used to examine the independent associations of each potential diagnostic parameter with lower extremity venous thrombosis in patients with hip fractures. Logistic regression analyses were further used to construct joint diagnostic indices incorporating multiple variables, including traditional parameters, i.e., demographic characteristics, coagulation parameters, and disease history, combined with TEG indicators. The diagnostic performance of each single and joint indicator was evaluated via receiver operating characteristic (ROC) curve analysis, with the area under the curve (AUC) utilized as the measure of diagnostic accuracy for lower extremity venous thrombosis in patients with hip fractures. The data were analyzed via SAS 9.4 (SAS Institute, Cary, North Carolina, United States of America), and statistical testing was conducted at a 2-tailed α level of 0.05. Results Participants The present study included a total of 74 patients; among them, 25 (33.78%) experienced thrombosis during the perioperative period. As shown in Table 1, there were no significant differences between the two groups in terms of age, sex, body mass index (BMI), fracture type, or comorbidities. Table 1. Characteristics of the study populations Characteristics With DVT N=25 Without DVT N=49 P value Age, median (IQR), year 82.0 (78.0, 87.0) 79.0 (70.0, 85.0) 0.053 Male sex, No. (%) 7 (28.0) 18 (36.7) 0.452 BMI, mean (SD), kg/m 2 23.2 (4.2) 21.9 (3.3) 0.139 Fracture type: FNF, No. (%) 12 (48.0) 34 (69.4) 0.093 Smoking, No. (%) 1 (4.0) 6 (12.2) 0.411 Comorbidities Hypertension, No. (%) 16 (64.0) 25 (51.0) 0.288 Diabetes, No. (%) 6 (24.0) 19 (38.8) 0.204 Coronary heart disease, No. (%) 4 (16.0) 9 (18.4) 0.800 Pulmonary insufficiency, No. (%) 2 (8.0) 1 (2.0) 0.262 Heart failure, No. (%) 2 (8.0) 1 (2.0) 0.262 Abbreviations: BMI, body mass index; DVT, venous thromboembolism; FNF, femoral neck fracture. Anticoagulation parameters This study focused on the comparison of thrombelastography (TEG) parameters (R, K, MA, α angle, and CI), PT, APTT, D-dimer, and PLT between the "with DVT" and "without DVT" groups. The R values at discharge for the "With DVT" and "Without DVT" groups were 5.8 min and 6.3 min, respectively, indicating a significant difference between the two groups (p=0.035). The concentration of D-dimer in the blood of the "With DVT" group was significantly greater than that in the "Without DVT" group (4.3 vs. 2.9 mg/L, p=0.029). There were no significant differences in the remaining coagulation parameters between the two groups (Table 2). Table 2 Coagulation indices With DVT Without DVT P value TEG R, min 5.8 (5.2, 6.8) 6.3 (5.8, 7.6) 0.035 K, min 1.6 (1.3,1.8) 1.5 (1.3,1.9) 0.905 MA, mm 64.5 (56.1, 67.4) 62.4 (57.7, 66.3) 0.834 α Angle, ° 67.4 (63.0, 71.8) 67.1 (61.7, 70.9) 0.797 CI 0.6 (-1.1, 1.5) 0.2 (-1.4, 1.0) 0.336 PT, s 14.0 (13.4, 14.7) 14.0 (13.5, 14.7) 0.766 APTT, s 40.2 (35.2, 43.7) 39.0 (36.8, 43.6) 0.956 D-dimer, mg/L 4.3 (2.3, 8.5) 2.9 (1.9, 4.2) 0.029 PLT,/L 180.0 (122.0, 212.0) 184.0 (153.0, 217.5) 0.390 TEG: thromboelastogram; PT: prothrombin time; APTT: activated partial thromboplastin time; PLT: platelet count; K: kinetics time; R: reaction time; MA: maximum amplitude; α angle: kinetics of plot development; CI: complex index. Correlation between Coagulation Parameters and DVT Among the aforementioned coagulation parameters, the R values of TEG, D-dimer, and BMI were significantly associated with the occurrence of DVT, with odds ratios (ORs) of 0.43, 1.43, and 1.25, respectively (p=0.024, 0.009, 0.032). Although the odds ratios for hypertension and coronary heart disease were 2.51 and 0.54, respectively, they did not reach statistical significance (p>0.05) (Table 3). Table 3 presents the results of multivariate logistic regression analysis with DVT as the dependent variable and TEG parameters, age, sex, BMI, and comorbidities as independent variables. DVT OR 95% CI P value R, min 0.43 0.20, 0.89 0.024 K, min 0.58 0.05, 6.56 0.658 MA, mm 0.98 0.82, 1.17 0.817 α Angle, ° 0.93 0.75, 1.15 0.476 PT, s 0.51 0.19, 1.39 0.191 APTT, s 1.09 0.94, 1.26 0.263 D-dimer , mg/L 1.43 1.09, 1.87 0.009 PLT,/L 1.00 0.98, 1.02 0.900 Age 1.06 0.99, 1.14 0.117 Sex male 0.60 0.14, 2.56 0.493 BMI 1.25 1.02, 1.54 0.032 Hypertension 2.51 0.50, 12.53 0.262 Diabetes 0.60 0.12, 3.00 0.536 Coronary heart disease 0.54 0.06, 4.60 0.571 K: kinetics time; R: reaction time; MA: maximum amplitude; α angle: kinetics of plot development; CI: complex index; PT: prothrombin time; APTT: activated partial thromboplastin time; PLT: platelet count; BMI: body mass index. Diagnostic Value of Single and Composite Indicators for DVT Among the individual laboratory test parameters, D-dimer had the highest area under the curve (AUC) (0.6772), whereas APTT had the smallest AUC (0.4792). In the thrombelastography (TEG) analysis, the R value had the highest AUC at 0.6758, whereas the MA had the smallest AUC at 0.4958 (Figure 1). We combined TEG parameters, traditional coagulation indicators (PT, APTT, D-dimer, and PLT), and patient history (age, sex, fracture type, BMI, and comorbidities) individually and calculated the AUCs of the ROC curves. As more indicators were included, the AUC gradually increased, reaching a maximum of 0.8224 (Figure 2). From the perspective of combining individual indicators, the AUC was highest for the combination of R+CI+αangle+D-dimer, at 0.7475, followed by R+CI+αangle+BMI, at 0.7123. The lowest AUC was observed for the combination of R+CI+αangle+sex, at 0.5920 (Figure 3). Discussion TEG has emerged as a critical measure of coagulation status and a primary reference for blood product transfusion in various medical fields, including surgical intensive care units and stroke management. Some scholars have researched the application of TEG in orthopedics, specifically its role in DVT. However, existing studies have predominantly investigated the correlation between specific TEG parameters and thrombus formation, neglecting the combined diagnostic and predictive value of TEG in conjunction with traditional coagulation indicators. This study addresses the elderly population at high risk for lower extremity venous thrombosis, specifically those with hip fractures, by constructing different combinations of laboratory indicators for diagnosing and predicting new thrombosis. These results indicate that traditional coagulation indicators exhibit suboptimal diagnostic efficacy for new DVTs. TEG has good diagnostic value for new thromboses, and its diagnostic efficacy is further enhanced when TEG is combined with traditional coagulation indicators. Currently, widely employed clinical indicators reflecting the activation status of intravascular coagulation factors include PT, APTT, fibrinogen, and D-dimer. Multiple studies emphasize the limited comprehensive objectivity of traditional coagulation tests in predicting bleeding, coagulation status, or transfusion outcomes. The application of traditional coagulation tests remains controversial, making clinical decision-making for the prevention and treatment of lower extremity venous thrombosis challenging 16-18 . This study revealed that, even with anticoagulant treatment based on expert consensus for thrombosis prevention in elderly hip fracture patients, 33.78% of patients developed new thrombosis during the perioperative period, which is slightly higher than that reported in some studies. Research by Fu et al. investigating the incidence and risk factors for postoperative DVT in patients with femoral neck fractures revealed a preoperative DVT incidence of 32% and a postoperative DVT incidence of 56%. Peripheral DVT accounts for 90% and 84% of preoperative and postoperative DVTs, respectively 19 . Studies conducted by researchers such as Huang Yongdong, who used low-molecular-weight heparin and rivaroxaban to prevent DVT in patients after intertrochanteric femur fractures, revealed that even with the use of these two medications, the incidence of DVT remained as high as 5.56% and 5.88%, respectively. Wu Ge et al. applied low-molecular-weight heparin and rivaroxaban for DVT prevention after total hip arthroplasty and femoral head replacement surgeries and reported that the incidence of DVT remained high at 20% and 11.1%, respectively 20, 21 . These results indicate that standardized anticoagulation measures still struggle to completely prevent the formation of deep vein thrombosis. Early identification of newly developed DVT in elderly hip fracture patients is highly important. In previous studies, PT, APTT, D-dimer, and the PLT were selected as representative indicators for traditional coagulation function testing. The results indicate that only an elevated D-dimer level was strongly correlated with the incidence of DVT. The risk of developing DVT in elderly hip fracture patients with elevated D-dimer levels was 1.43 times greater than that in patients with normal D-dimer levels. Moreover, D-dimer was the most effective diagnostic indicator among these four traditional coagulation parameters. Wang et al., in their study of chest trauma patients, similarly reported that D-dimer is a risk factor for DVT occurrence 4 . The ROC curves for PT, APTT, and the PLT count all had areas under the curve (AUCs) of approximately 50%, indicating that individual indicators within traditional coagulation function testing have relatively low diagnostic efficacy for new-onset DVT in elderly hip fracture patients. Takahiro et al. reported that, in patients with lower limb fractures, D-dimer levels on the third day after injury and the third day postsurgery were not significantly different between those with and without venous thromboembolism 22 . For the majority of seriously traumatized patients without venous thromboembolism, D-dimer levels are positive, suggesting that D-dimer measurement within 48 hours of injury may not have diagnostic value for new-onset DVT. TEG has become an important alternative and complementary method in traditional coagulation research. Among the five TEG parameters selected in this study, the individual diagnostic capabilities of R, K, MA, CI, and the α angle for new-onset DVT in elderly hip fracture patients were superior to those of APTT. The R value demonstrated diagnostic capabilities comparable to those of D-dimer. Zeng X et al. reported a multicenter reference range for thromboelastography in Chinese adults, providing an application basis for TEG in traditional coagulation research on the Chinese adult population 23 . Compared with traditional coagulation function testing methods, the advantages of TEG are its use of whole blood, short analysis time, and provision of comprehensive information about the dynamic formation and strength of blood clots 1 . The value of combined diagnosis is not necessarily always greater than that of individual indicators. The diagnostic efficacy of the R+CI+α angle+D-dimer combined diagnostic scheme was the highest, followed by the R+CI+α angle+BMI combined scheme. This suggests that the patient's lifestyle can also be considered in the diagnostic criteria, indicating the potential for selectively combining TEG, traditional coagulation indicators, patient history, and general lifestyle as a scoring scale for diagnosing and predicting new-onset thrombosis in elderly hip fracture patients. Additionally, we found that the diagnostic efficacy of the R+CI+α angle+gender combined scheme was even lower than the individual diagnostic efficacy of the R value. This indicates that it is not advisable to indiscriminately include as many indicators as possible in pursuit of the highest diagnostic efficacy without selective screening. Limitations The limitations of this study lie in its exclusive focus on perioperative thrombotic events in elderly hip fracture patients, as long-term follow-up outcomes are lacking. However, the perioperative period following hip fracture surgery in the elderly represents a peak period for new thrombotic events. With increasing postoperative time, the mobility of elderly patients gradually increases, and the risk of thrombosis formation decreases progressively. This study conducted an integrated analysis concerning laboratory diagnosis and high-risk factors for new-onset thrombosis in elderly hip fracture patients during the perioperative period, laying the foundation for subsequent large-scale, long-term research. Conclusion This study not only explored the independent predictive capacity of TEG for DVT but also analyzed the comprehensive predictive ability of TEG in combination with traditional coagulation function testing indicators for DVT. The research findings indicate that among the individual indicators, the R value of the TEG has the highest diagnostic value for new thrombotic events in elderly hip fracture patients, closely followed by D-dimer. The combined diagnostic value is maximized when R+CI+Angle+D-dimer is incorporated. These laboratory test data provide robust support for the establishment of a relatively comprehensive diagnostic and predictive scoring system for DVT in elderly hip fracture patients. Declarations Ethical approval The study complied with all the relevant national regulations and institutional policies and was conducted in accordance with the tenets of the Helsinki Declaration. This study was approved by the ethical committee of China-Japan Friendship Hospital (ref. number: 2023-KY-145), and although the study was considered to have a minimal risk for patients since the blood samples for the TEG analysis were collected as part of routinely performed blood draws and no additional blood draws were performed, written consent was obtained from every patient. Funding Sources Statement This study was supported by National High Level Hospital Clinical Research Funding (No. 2023-NHLHCRF-YYPPLC-ZR-12), the Elite Medical Professionals Project of China-Japan Friendship Hospital (No. ZRJY2023-QM29), and the China-Japan Friendship Hospital Self-selected Project (No. 2023-HX-46). Author Contribution Author ContributionsHuan Yang (First Author): Conceptualization, design of the work, investigation, formal analysis, writing - original draft;Yusong Yuan: Data Curation, methodology, software, formal analysis.Lei Shi: the acquisition,Investigation,analysis.Yurun Yang: the acquisition,Investigation, Data Curation.Yidan Zhu*(Corresponding Author):the creation of new software used in the work, Interpretation of data.Ying Chen*(Corresponding Author): Resources, Supervision, Writing - Review & Editing.All authors have approved the submitted version and have agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature. Data Availability Sequence data that support the findings of this study have been deposited in "Figshare" and could be asccessed via DOI:10.6084/m9.figshare.27159117 References Lasocki S, Capdevila X, Vielle B, Bijok B, Lahlou-Casulli M, Collange V, Grillot N, Danguy des Deserts M, Duchalais A, Delannoy B, Drugeon B, Bouzat P, David JS, Rony L, Loupec T, Leger M, Rineau E, Hi FITI, network Sr. Ferric derisomaltose and tranexamic acid, combined or alone, for reducing blood transfusion in patients with hip fracture (the shift trial): A multicentre, 2 x 2 factorial, randomized, double-blind, controlled trial. Lancet Haematol . 2023;10:e747-e755 Miyamoto RG, Kaplan KM, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: An evidence-based review of the literature. I: Femoral neck fractures. J Am Acad Orthop Surg . 2008;16:596-607 Meng H, Zhu Y, Zhang J, Li J, Zhao K, Zhang Y, Chen W. Incidence and a risk factor for preoperative deep vein thrombosis (DVT) in isolated calcaneal fracture, a prospective cohort study. Foot Ankle Surg . 2021;27:510-514 Wang PF, Li JH, Fei C, Li Z, Ke C, Shang K, Cong YX, Qu SW, Zhang BF, Zhuang Y, Zhang K. Deep vein thrombosis in the uninjured limb in patients with lower extremity fractures: A retrospective study. Biomed Res Int . 2020;2020:1647617 Sun Y, Chen D, Xu Z, Shi D, Dai J, Qin J, Jiang Q. Incidence of symptomatic and asymptomatic venous thromboembolism after elective knee arthroscopic surgery: A retrospective study with routinely applied venography. Arthroscopy . 2014;30:818-822 Fallaha MA, Radha S, Patel S. Safety and efficacy of a new thromboprophylaxis regiment for total knee and total hip replacement: A retrospective cohort study in 265 patients. Patient Saf Surg . 2018;12:22 Goh EL, Gurung PK, Ma S, Pilpel T, Dale JH, Kannan A, Anand S. Direct oral anticoagulants in the prevention of venous thromboembolism following surgery for hip fracture in older adults: A population-based cohort study. Geriatr Orthop Surg Rehabil . 2020;11:2151459319897520 Gong C, Yu K, Zhang N, Huang J. Predictive value of thromboelastography for postoperative lower extremity deep venous thrombosis in gastric cancer complicated with portal hypertension patients. Clin Exp Hypertens . 2021;43:196-202 Smith EB, Parvizi J, Purtill JJ. Delayed surgery for patients with femur and hip fractures risk of deep venous thrombosis. J Trauma . 2011;70:E113-116 Kehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. Br J Anaesth . 1997;78:606-617 Tantry US, Gurbel PA. Assessment of oral antithrombotic therapy by platelet function testing. Nat Rev Cardiol . 2011;8:572-579 Tsantes AG, Papadopoulos DV, Trikoupis IG, Tsante KA, Mavrogenis AF, Koulouvaris P, Piovani D, Kriebardis AG, Gialeraki A, Nikolopoulos GK, Bonovas S, Papagelopoulos PJ, Tsantes AE. Rotational thromboelastometry findings are associated with symptomatic venous thromboembolic complications after hip fracture surgery. Clin Orthop Relat Res . 2021;479:2457-2467 Bell SF, de Lloyd L, Preston N, Collins PW. Managing the coagulopathy of postpartum hemorrhage: An evolving role for viscoelastic hemostatic assays. J Thromb Hemost . 2023;21:2064-2077 You D, Skeith L, Korley R, Cantle P, Lee A, McBeth P, McDonald B, Buckley R, Duffy P, Martin CR, Soo A, Schneider P. Identification of hypercoagulability with thrombelastography in patients with hip fracture receiving thromboprophylaxis. Can J Surg . 2021;64:E324-E329 Xu X, Jiang J, Liu W, Li X, Lu H. Application of thromboelastography to evaluate the effect of different routes administration of tranexamic acid on coagulation function in total hip arthroplasty. J Orthop Surg Res . 2019;14:430 Mou Y, Li M, Hou S, Ren X, Tian B. Assessment of preoperative hypercoagulability in patients with pancreatic ductal adenocarcinoma (PDAC) using rapid thromboelastography (r-teg). J Thromb Thrombolysis . 2019;48:648-652 Chang HW, Lee IO, Kang H, Won YJ, Lim YS. Coagulation effect of sugammadex as determined by thromboelastography in a randomized controlled study of surgical patients. Int J Med Sci . 2021;18:1318-1324 Fu YH, Liu P, Xu X, Wang PF, Shang K, Ke C, Fei C, Yang K, Zhang BF, Zhuang Y, Zhang K. Deep vein thrombosis in the lower extremities after femoral neck fracture: A retrospective observational study. J Orthop Surg (Hong Kong) . 2020;28:2309499019901172 Niikura T, Sakai Y, Lee SY, Iwakura T, Nishida K, Kuroda R, Kurosaka M. D-dimer levels to screen for venous thromboembolism in patients with fractures caused by high-energy injuries. J Orthop Sci . 2015;20:682-688 Abatzis-Papadopoulos M, Tigkiropoulos K, Nikas S, Papoutsis I, Kostopoulou O, Stavridis K, Karamanos D, Lazaridis I, Saratzis N. The effectiveness and safety of direct oral anticoagulants compared to conventional pharmacologic thromboprophylaxis in hip fracture patients: A systematic review and meta-analysis of randomized controlled trials. Orthop Traumatol Surg Res . 2023;109:103364 Harder S, Graff J. Novel oral anticoagulants: Clinical pharmacology, indications and practical considerations. Eur J Clin Pharmacol . 2013;69:1617-1633 Zeng X, Fang L, Peng Y, Zhang Y, Li X, Wang Z, Zhang B, Cao Q, Hu X. A multicenter reference interval study of thromboelastography in the Chinese adult population. Thromb Res . 2020;195:180-186 Olson JC. Thromboelastography-guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: A randomized controlled trial. Clin Liver Dis (Hoboken) . 2019;13:102-105 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 24 Dec, 2024 Read the published version in Journal of Orthopaedic Surgery and Research → Version 1 posted Editorial decision: Revision requested 04 Dec, 2024 Reviews received at journal 18 Nov, 2024 Reviewers agreed at journal 10 Nov, 2024 Reviewers invited by journal 14 Oct, 2024 Editor assigned by journal 03 Oct, 2024 Submission checks completed at journal 03 Oct, 2024 First submitted to journal 03 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5198509","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":386352584,"identity":"54ca2f20-7af0-483b-b1c2-dc706badbc68","order_by":0,"name":"Huan Yang","email":"","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":false,"prefix":"","firstName":"Huan","middleName":"","lastName":"Yang","suffix":""},{"id":386352585,"identity":"82d73b30-a3ad-47f6-a9e6-9aaf750aed8f","order_by":1,"name":"MD，Yusong Yuan","email":"","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":false,"prefix":"","firstName":"MD，Yusong","middleName":"","lastName":"Yuan","suffix":""},{"id":386352586,"identity":"41288ed4-f4db-4383-8355-31729d70be8b","order_by":2,"name":"PhD，Lei Shi","email":"","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":false,"prefix":"","firstName":"PhD，Lei","middleName":"","lastName":"Shi","suffix":""},{"id":386352587,"identity":"429db0a5-9903-4fce-b745-86538307c869","order_by":3,"name":"MD，Yurun Yang","email":"","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":false,"prefix":"","firstName":"MD，Yurun","middleName":"","lastName":"Yang","suffix":""},{"id":386352588,"identity":"bb9eeb85-21b4-4445-aff4-e6799e4730cd","order_by":4,"name":"Yidan Zhu","email":"","orcid":"","institution":"Peking University","correspondingAuthor":false,"prefix":"","firstName":"Yidan","middleName":"","lastName":"Zhu","suffix":""},{"id":386352589,"identity":"df4684d8-20e0-48de-bda0-10766de22d99","order_by":5,"name":"Ying Chen","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAs0lEQVRIiWNgGAWjYLACxgYbHn7+BtK0pMlIzjhAmpbDNgYNCUSq5p+R/uwz747zPAYMBxg/fMwhQovEjYTk2bxnbvOYMzcwS87cRoQWA4mEw8y8bbd5LBsOsDHzEqclsRmo5RyPwYEEorUkMwO1HCBBi8SZZ8yMc9uSeSRnHGwmzi/87emPGd622dnz8zcf/PCRGC0MAgkMTDxgFmMDMepB1hxgYPxBpNpRMApGwSgYoQAAUIQzwtDXBGQAAAAASUVORK5CYII=","orcid":"","institution":"China-Japan Friendship Hospital","correspondingAuthor":true,"prefix":"","firstName":"Ying","middleName":"","lastName":"Chen","suffix":""}],"badges":[],"createdAt":"2024-10-03 13:08:13","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5198509/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5198509/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s13018-024-05386-4","type":"published","date":"2024-12-24T15:57:35+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":71478189,"identity":"c8d5a4bc-2551-4852-8261-cbddce5046a9","added_by":"auto","created_at":"2024-12-16 05:30:30","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":55077,"visible":true,"origin":"","legend":"\u003cp\u003eROC curves for individual TEG parameters and the four traditional coagulation indicators for diagnosing DVT.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5198509/v1/4af75472b24b62c565944f9f.png"},{"id":71478822,"identity":"ca659041-6126-48de-a6aa-6b7a4a873843","added_by":"auto","created_at":"2024-12-16 05:38:30","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":36586,"visible":true,"origin":"","legend":"\u003cp\u003eROC curves for the combined diagnosis of DVT using the overall TEG indicator. The combined diagnosis of DVT via various TEG parameters is labeled \"joint indicator 1,\" whereas the combination of TEG parameters with traditional coagulation indicators for DVT diagnosis is labeled \"joint indicator 2.\" The combined diagnosis of DVT via TEG, traditional coagulation indicators, and epidemiological indicators is denoted as \"joint indicator 3.\"\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5198509/v1/9ed623aab4ebf3b3cd4229c5.png"},{"id":71478191,"identity":"4f3ace91-1b4d-4277-957d-91572bb5a6e1","added_by":"auto","created_at":"2024-12-16 05:30:30","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":52599,"visible":true,"origin":"","legend":"\u003cp\u003eROC curves for the combined diagnosis of DVT via individual TEG parameters in conjunction with other indicators.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5198509/v1/41d84af696131fa1f51256a6.png"},{"id":72641791,"identity":"d6fde33b-9ff2-4da5-9658-50d776303cd9","added_by":"auto","created_at":"2024-12-30 16:18:13","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":582959,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5198509/v1/72a96248-a050-444d-b123-e8497d464a94.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Enhanced diagnostic capabilities of thromboelastography coupled with standard coagulation indices for predicting perioperative thrombosis in older individuals with hip fractures","fulltext":[{"header":"Introduction","content":"\u003cp\u003eElderly hip fractures refer to fractures of the femoral neck and intertrochanteric and subtrochanteric regions caused by low-energy trauma in individuals aged 60 and older \u003csup\u003e\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e. Hip fractures account for 18.2% of all fractures, and with the increasing aging population in China, the incidence of hip fractures continues to rise\u003csup\u003e\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. It is projected that by the year 2050, the annual number of elderly patients with hip fractures will reach 6.3 million\u003csup\u003e\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Deep vein thrombosis (DVT) in the lower extremities is one of the most common complications in patients with hip fractures. Following injury, immobilization of the affected limb leads to reduced blood flow velocity, and tissue damage activates the immune‒inflammatory system, resulting in hypercoagulability. This cascade of events ultimately contributes to the formation of DVTs in the lower extremities\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e. Approximately 75% of all cases of deep vein thrombosis are asymptomatic\u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. Studies on the Chinese population indicate a high incidence of lower extremity DVT in elderly hip fracture patients, estimated at approximately 29.8%\u003csup\u003e7\u003c/sup\u003e. Even with the preoperative administration of low-molecular-weight heparin, the occurrence rate of lower extremity DVT in hip fracture patients remains at 3.4%\u003csup\u003e8\u003c/sup\u003e. Additionally, 20.1% of elderly hip fracture patients are reported to have DVT upon admission\u003csup\u003e\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e. Elderly patients with hip fractures, once afflicted with lower extremity deep vein thrombosis (DVT), face numerous adverse outcomes, yet effective laboratory predictive and diagnostic methods are lacking. A prospective study revealed that hip fracture patients with concurrent lower extremity DVT had an average surgical delay of 5.7 days, whereas those without lower extremity DVT had an average delay of 3.2 days\u003csup\u003e\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e. In individuals aged 65 years and above, the mortality rate within 30 days for DVT patients reaches 11%, increasing to 31% within one year\u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. While trauma patients with fractures and concomitant deep vein thrombosis have garnered considerable attention, several studies indicate that traditional coagulation tests lack comprehensive objectivity in assessing coagulation function, particularly in the absence of personalized laboratory diagnostic and predictive criteria for perioperative thrombosis in elderly hip fracture patients.\u003c/p\u003e \u003cp\u003eThromboelastography (TEG) is an emerging laboratory testing method for evaluating coagulation status. TEG dynamically assesses the entire coagulation process, providing qualitative and quantitative indicators of clot formation by evaluating the status of coagulation, platelet aggregation, and fibrinolysis\u003csup\u003e\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. The key TEG parameters include the reaction time (R), which is the time from the initiation of the first fibrin strand and represents the functionality of the quantity and coagulation factors; coagulation time (K), which is the time from the initiation of fibrin formation until clot formation, predominantly assessing coagulation factors, platelets, and fibrinogen; α-angle (α), which reflects the speed of clot formation, with higher values indicating rapid clot formation and lower values indicating delayed and compromised formation of maximum clot strength; and maximum amplitude (MA), which is the maximum strength of the clot and is dependent on the quantity and interaction of fibrinogen and platelets. An increase in MA suggests a hypercoagulable state or impaired platelet function\u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eGiven that thromboelastography (TEG) has been firmly established as a diagnostic marker for thrombotic disorders, such as DIC, the potential utility of TEG in predicting thrombotic events among hospitalized hip fracture patients is unclear. Accordingly, the principal aim of this study was to assess the diagnostic accuracy of TEG, when used in conjunction with standard coagulation markers, for the prompt recognition of incident lower extremity deep vein thrombosis (DVT) in elderly patients with hip fractures. The secondary objective is to identify early thrombotic disorders rather than relying solely on ultrasound devices to confirm the presence of thrombosis.\u003c/p\u003e \u003cp\u003eThis study established a perioperative thrombosis cohort of elderly hip fracture patients, with lower extremity venous ultrasound results as the gold standard. This study explores the diagnostic and predictive value of individual TEG parameters, combinations of TEG parameters, and the integration of TEG parameters with traditional coagulation indicators, such as six indices of coagulation, a classic coagulation function test project in China involving prothrombin time (PT), activated partial thromboplastin time (APTT), D-dimer, prothrombin time activity (PTA), international normalized ratio (INR), fibrinogen (Fib), etc., for the prevention and treatment of lower extremity venous thrombosis in elderly hip fracture patients, with the aim of providing robust data support and reference for the prevention and treatment of lower extremity venous thrombosis in these patients.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy population\u003c/h2\u003e \u003cp\u003eThis retrospective study was conducted on patients admitted to the China-Japan Friendship Hospital. All patients with hip fractures between November 1, 2022, and October 31, 2023, were screened for eligibility.\u003c/p\u003e \u003cp\u003eThe inclusion criteria were as follows: 1) had a femoral neck fracture, intertrochanteric fracture, or subtrochanteric fracture; 2) were aged greater than or equal to 65 years; 3) had undergone internal fixation or joint prosthesis replacement surgery; and 4) had a postoperative hospital stay of more than 3 days.\u003c/p\u003e \u003cp\u003eThe exclusion criteria for patients were as follows: 1) incomplete medical records; 2) diagnosed with deep venous thrombosis of the lower extremity at admission by ultrasound; 3) suffering from blood system diseases; 4) received anticoagulant therapy before the injury, except for single antiplatelet drugs; 5) severe liver or kidney dysfunction: transaminase\u0026thinsp;\u0026gt;\u0026thinsp;\u003cem\u003e80 U\u003c/em\u003e/L, blood creatinine\u0026thinsp;\u0026gt;\u0026thinsp;178 \u0026micro;mol/L; 6) severe infectious diseases; and 7) suffering from malignant tumors.\u003c/p\u003e \u003cp\u003ePerioperative anticoagulation management\u003c/p\u003e \u003cp\u003eAll patients received anticoagulant therapy during hospitalization, including health education, graduated compression stockings, and low-molecular-weight heparin (LMWH). Patients who were receiving anticoagulation medications before surgery continued their medications after 30 days of LMWH treatment. The LMWH dose was adjusted for patients with renal insufficiency and a glomerular filtration rate (GFR)\u0026thinsp;\u0026lt;\u0026thinsp;20 mL/min (2500 IUs for patients 30\u0026ndash;50 kg, 3500 IUs for patients 50\u0026ndash;150 kg, and 50 IUs/kg for patients\u0026thinsp;\u0026lt;\u0026thinsp;30 kg or \u0026gt;\u0026thinsp;150 kg)\u003csup\u003e\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eData collection\u003c/h3\u003e\n\u003cp\u003eTEG Test Methods\u003c/p\u003e \u003cp\u003eAt the time of admission and discharge, the patient's blood routine, TEG, six-item coagulation, and lower extremity venous color Doppler ultrasound were performed. On the first day after the operation, routine blood tests, TEG, and coagulation tests were performed. Patient demographic information was collected at the time of admission.\u003c/p\u003e \u003cp\u003eThe indices of the TEG included the kinetics time (K), reaction time (R), maximum amplitude (MA), kinetics of plot development (α angle), and complex index (CI) value. The six indices of coagulation include PT, APTT, and D-dimer. The index of routine blood tests is the PLT.\u003c/p\u003e \u003cp\u003eWhole-blood TEG was performed with a TEG 6 s hemostasis analyzer (Hemonetics). Patient blood was collected in 2.7 mL tubes containing 3.2% buffered sodium citrate solution and transported to the orthopedic trauma research laboratory. Approximately 0.4 mL of whole blood was manually pipetted into the TEG 6 s cartridge entry port for analysis. All tests were performed within 4 hours of blood collection, as recommended by the manufacturer. The members of our orthopedic trauma research team were trained in using the TEG 6 s system and performed all tests\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eContinuous variables are presented as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations (SDs) or medians (lower and upper quartiles), and categorical variables are presented as numbers and percentages. Characteristics were compared between groups with and without newly occurring DVT via t tests, Wilcoxon rank sum tests, χ2 tests, or Fisher\u0026rsquo;s exact tests. The simple correlations between each coagulation parameter, including TEG, PT, APTT, D-dimer, PLT, and lower extremity venous thrombosis, were examined via Wilcoxon rank sum tests. Multivariate logistic regression analysis was used to examine the independent associations of each potential diagnostic parameter with lower extremity venous thrombosis in patients with hip fractures. Logistic regression analyses were further used to construct joint diagnostic indices incorporating multiple variables, including traditional parameters, i.e., demographic characteristics, coagulation parameters, and disease history, combined with TEG indicators. The diagnostic performance of each single and joint indicator was evaluated via receiver operating characteristic (ROC) curve analysis, with the area under the curve (AUC) utilized as the measure of diagnostic accuracy for lower extremity venous thrombosis in patients with hip fractures.\u003c/p\u003e \u003cp\u003eThe data were analyzed via SAS 9.4 (SAS Institute, Cary, North Carolina, United States of America), and statistical testing was conducted at a 2-tailed α level of 0.05.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eParticipants\u003c/p\u003e\n\u003cp\u003eThe present study included a total of 74 patients; among them, 25 (33.78%) experienced thrombosis during the perioperative period. As shown in Table 1, there were no significant differences between the two groups in terms of age, sex, body mass index (BMI), fracture type, or comorbidities.\u003c/p\u003e\n\u003cp\u003eTable 1. Characteristics of the study populations\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003eWith DVT\u003c/p\u003e\n \u003cp\u003eN=25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003eWithout DVT\u003c/p\u003e\n \u003cp\u003eN=49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eAge, median (IQR), year\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e82.0 (78.0, 87.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 128px;\"\u003e\n \u003cp\u003e79.0 (70.0, 85.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.053\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eMale sex, No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e7 (28.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e18 (36.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eBMI, mean (SD), kg/m\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e23.2 (4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e21.9 (3.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.139\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eFracture type: FNF, No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e12 (48.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e34 (69.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.093\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eSmoking, No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (4.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 (12.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.411\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eComorbidities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eHypertension, No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e16 (64.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e25 (51.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.288\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eDiabetes, No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e6 (24.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e19 (38.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.204\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eCoronary heart disease, No. (%)\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e4 (16.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e9 (18.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.800\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003ePulmonary insufficiency, No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 255px;\"\u003e\n \u003cp\u003eHeart failure, No. (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e2 (8.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 128px;\"\u003e\n \u003cp\u003e1 (2.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: BMI, body mass index; DVT, venous thromboembolism; FNF, femoral neck fracture.\u003c/p\u003e\n\u003cp\u003eAnticoagulation parameters\u003c/p\u003e\n\u003cp\u003eThis study focused on the comparison of thrombelastography (TEG) parameters (R, K, MA, \u0026alpha; angle, and CI), PT, APTT, D-dimer, and PLT between the \u0026quot;with DVT\u0026quot; and \u0026quot;without DVT\u0026quot; groups. The R values at discharge for the \u0026quot;With DVT\u0026quot; and \u0026quot;Without DVT\u0026quot; groups were 5.8 min and 6.3 min, respectively, indicating a significant difference between the two groups (p=0.035). The concentration of D-dimer in the blood of the \u0026quot;With DVT\u0026quot; group was significantly greater than that in the \u0026quot;Without DVT\u0026quot; group (4.3 vs. 2.9 mg/L, p=0.029). There were no significant differences in the remaining coagulation parameters between the two groups (Table 2).\u003c/p\u003e\n\u003cp\u003eTable 2 Coagulation indices\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003eWith DVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003eWithout DVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eTEG\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eR, min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e5.8 (5.2, 6.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e6.3 (5.8, 7.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.035\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eK, min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e1.6 (1.3,1.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e1.5 (1.3,1.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.905\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eMA, mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e64.5 (56.1, 67.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e62.4 (57.7, 66.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.834\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003e\u0026alpha; Angle, \u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e67.4 (63.0, 71.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e67.1 (61.7, 70.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.797\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e0.6 (-1.1, 1.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e0.2 (-1.4, 1.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.336\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePT, s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e14.0 (13.4, 14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e14.0 (13.5, 14.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.766\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eAPTT, s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e40.2 (35.2, 43.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e39.0 (36.8, 43.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.956\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eD-dimer, mg/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e4.3 (2.3, 8.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e2.9 (1.9, 4.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.029\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePLT,/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e180.0 (122.0, 212.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 175px;\"\u003e\n \u003cp\u003e184.0 (153.0, 217.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.390\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eTEG: thromboelastogram; PT: prothrombin time; APTT: activated partial thromboplastin time; PLT: platelet count; K: kinetics time; R: reaction time; MA: maximum amplitude; \u0026alpha; angle: kinetics of plot development; CI: complex index.\u003c/p\u003e\n\u003cp\u003eCorrelation between Coagulation Parameters and DVT\u003c/p\u003e\n\u003cp\u003eAmong the aforementioned coagulation parameters, the R values of TEG, D-dimer, and BMI were significantly associated with the occurrence of DVT, with odds ratios (ORs) of 0.43, 1.43, and 1.25, respectively (p=0.024, 0.009, 0.032). Although the odds ratios for hypertension and coronary heart disease were 2.51 and 0.54, respectively, they did not reach statistical significance (p\u0026gt;0.05) (Table 3).\u003c/p\u003e\n\u003cp\u003eTable 3 presents the results of multivariate logistic regression analysis with DVT as the dependent variable and TEG parameters, age, sex, BMI, and comorbidities as independent variables.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003eDVT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003eOR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eR, min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e0.20, 0.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.024\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eK, min\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e0.05, 6.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.658\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eMA, mm\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e0.82, 1.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.817\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u0026alpha; Angle, \u0026deg;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e0.75, 1.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.476\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePT, s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e0.19, 1.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.191\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAPTT, s\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e0.94, 1.26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.263\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eD-dimer \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp; , mg/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e1.09, 1.87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.009\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003ePLT,/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e0.98, 1.02\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.900\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e0.99, 1.14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.117\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eSex male\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e0.14, 2.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.493\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e1.25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e1.02, 1.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e0.032\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eHypertension\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e2.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e0.50, 12.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.262\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eDiabetes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e0.12, 3.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.536\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eCoronary heart disease\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 97px;\"\u003e\n \u003cp\u003e0.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 205px;\"\u003e\n \u003cp\u003e0.06, 4.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 71px;\"\u003e\n \u003cp\u003e0.571\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eK: kinetics time; R: reaction time; MA: maximum amplitude; \u0026alpha; angle: kinetics of plot development; CI: complex index; PT: prothrombin time; APTT: activated partial thromboplastin time; PLT: platelet count; BMI: body mass index.\u003c/p\u003e\n\u003cp\u003eDiagnostic Value of Single and Composite Indicators for DVT\u003c/p\u003e\n\u003cp\u003eAmong the individual laboratory test parameters, D-dimer had the highest area under the curve (AUC) (0.6772), whereas APTT had the smallest AUC (0.4792). In the thrombelastography (TEG) analysis, the R value had the highest AUC at 0.6758, whereas the MA had the smallest AUC at 0.4958 (Figure 1).\u003c/p\u003e\n\u003cp\u003eWe combined TEG parameters, traditional coagulation indicators (PT, APTT, D-dimer, and PLT), and patient history (age, sex, fracture type, BMI, and comorbidities) individually and calculated the AUCs of the ROC curves. As more indicators were included, the AUC gradually increased, reaching a maximum of 0.8224 (Figure 2). From the perspective of combining individual indicators, the AUC was highest for the combination of R+CI+\u0026alpha;angle+D-dimer, at 0.7475, followed by R+CI+\u0026alpha;angle+BMI, at 0.7123. The lowest AUC was observed for the combination of R+CI+\u0026alpha;angle+sex, at 0.5920 (Figure 3).\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eTEG has emerged as a critical measure of coagulation status and a primary reference for blood product transfusion in various medical fields, including surgical intensive care units and stroke management. Some scholars have researched the application of TEG in orthopedics, specifically its role in DVT. However, existing studies have predominantly investigated the correlation between specific TEG parameters and thrombus formation, neglecting the combined diagnostic and predictive value of TEG in conjunction with traditional coagulation indicators. This study addresses the elderly population at high risk for lower extremity venous thrombosis, specifically those with hip fractures, by constructing different combinations of laboratory indicators for diagnosing and predicting new thrombosis. These results indicate that traditional coagulation indicators exhibit suboptimal diagnostic efficacy for new DVTs. TEG has good diagnostic value for new thromboses, and its diagnostic efficacy is further enhanced when TEG is combined with traditional coagulation indicators.\u003c/p\u003e\n\u003cp\u003eCurrently, widely employed clinical indicators reflecting the activation status of intravascular coagulation factors include PT, APTT, fibrinogen, and D-dimer. Multiple studies emphasize the limited comprehensive objectivity of traditional coagulation tests in predicting bleeding, coagulation status, or transfusion outcomes. The application of traditional coagulation tests remains controversial, making clinical decision-making for the prevention and treatment of lower extremity venous thrombosis challenging\u003csup\u003e16-18\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThis study revealed that, even with anticoagulant treatment based on expert consensus for thrombosis prevention in elderly hip fracture patients, 33.78% of patients developed new thrombosis during the perioperative period, which is slightly higher than that reported in some studies. Research by Fu et al. investigating the incidence and risk factors for postoperative DVT in patients with femoral neck fractures revealed a preoperative DVT incidence of 32% and a postoperative DVT incidence of 56%. Peripheral DVT accounts for 90% and 84% of preoperative and postoperative DVTs, respectively\u003csup\u003e19\u003c/sup\u003e. Studies conducted by researchers such as Huang Yongdong, who used low-molecular-weight heparin and rivaroxaban to prevent DVT in patients after intertrochanteric femur fractures, revealed that even with the use of these two medications, the incidence of DVT remained as high as 5.56% and 5.88%, respectively. Wu Ge et al. applied low-molecular-weight heparin and rivaroxaban for DVT prevention after total hip arthroplasty and femoral head replacement surgeries and reported that the incidence of DVT remained high at 20% and 11.1%, respectively\u003csup\u003e20, 21\u003c/sup\u003e. These results indicate that standardized anticoagulation measures still struggle to completely prevent the formation of deep vein thrombosis. Early identification of newly developed DVT in elderly hip fracture patients is highly important.\u003c/p\u003e\n\u003cp\u003eIn previous studies, PT, APTT, D-dimer, and the PLT were selected as representative indicators for traditional coagulation function testing. The results indicate that only an elevated D-dimer level was strongly correlated with the incidence of DVT. The risk of developing DVT in elderly hip fracture patients with elevated D-dimer levels was 1.43 times greater than that in patients with normal D-dimer levels. Moreover, D-dimer was the most effective diagnostic indicator among these four traditional coagulation parameters. Wang et al., in their study of chest trauma patients, similarly reported that D-dimer is a risk factor for DVT occurrence\u003csup\u003e4\u003c/sup\u003e. The ROC curves for PT, APTT, and the PLT count all had areas under the curve (AUCs) of approximately 50%, indicating that individual indicators within traditional coagulation function testing have relatively low diagnostic efficacy for new-onset DVT in elderly hip fracture patients. Takahiro et al. reported that, in patients with lower limb fractures, D-dimer levels on the third day after injury and the third day postsurgery were not significantly different between those with and without venous thromboembolism\u003csup\u003e22\u003c/sup\u003e. For the majority of seriously traumatized patients without venous thromboembolism, D-dimer levels are positive, suggesting that D-dimer measurement within 48 hours of injury may not have diagnostic value for new-onset DVT.\u003c/p\u003e\n\u003cp\u003eTEG has become an important alternative and complementary method in traditional coagulation research. Among the five TEG parameters selected in this study, the individual diagnostic capabilities of R, K, MA, CI, and the α angle for new-onset DVT in elderly hip fracture patients were superior to those of APTT. The R value demonstrated diagnostic capabilities comparable to those of D-dimer. Zeng X et al. reported a multicenter reference range for thromboelastography in Chinese adults, providing an application basis for TEG in traditional coagulation research on the Chinese adult population\u003csup\u003e23\u003c/sup\u003e. Compared with traditional coagulation function testing methods, the advantages of TEG are its use of whole blood, short analysis time, and provision of comprehensive information about the dynamic formation and strength of blood clots\u003csup\u003e1\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003eThe value of combined diagnosis is not necessarily always greater than that of individual indicators. The diagnostic efficacy of the R+CI+α angle+D-dimer combined diagnostic scheme was the highest, followed by the R+CI+α angle+BMI combined scheme. This suggests that the patient's lifestyle can also be considered in the diagnostic criteria, indicating the potential for selectively combining TEG, traditional coagulation indicators, patient history, and general lifestyle as a scoring scale for diagnosing and predicting new-onset thrombosis in elderly hip fracture patients. Additionally, we found that the diagnostic efficacy of the R+CI+α angle+gender combined scheme was even lower than the individual diagnostic efficacy of the R value. This indicates that it is not advisable to indiscriminately include as many indicators as possible in pursuit of the highest diagnostic efficacy without selective screening.\u003c/p\u003e\n\u003cp\u003eLimitations\u003c/p\u003e\n\u003cp\u003eThe limitations of this study lie in its exclusive focus on perioperative thrombotic events in elderly hip fracture patients, as long-term follow-up outcomes are lacking. However, the perioperative period following hip fracture surgery in the elderly represents a peak period for new thrombotic events. With increasing postoperative time, the mobility of elderly patients gradually increases, and the risk of thrombosis formation decreases progressively. This study conducted an integrated analysis concerning laboratory diagnosis and high-risk factors for new-onset thrombosis in elderly hip fracture patients during the perioperative period, laying the foundation for subsequent large-scale, long-term research.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study not only explored the independent predictive capacity of TEG for DVT but also analyzed the comprehensive predictive ability of TEG in combination with traditional coagulation function testing indicators for DVT. The research findings indicate that among the individual indicators, the R value of the TEG has the highest diagnostic value for new thrombotic events in elderly hip fracture patients, closely followed by D-dimer. The combined diagnostic value is maximized when R+CI+Angle+D-dimer is incorporated. These laboratory test data provide robust support for the establishment of a relatively comprehensive diagnostic and predictive scoring system for DVT in elderly hip fracture patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study complied with all the relevant national regulations and institutional policies and was conducted in accordance with the tenets of the Helsinki Declaration. This study was approved by the ethical committee of China-Japan Friendship Hospital (ref. number: 2023-KY-145), and although the study was considered to have a minimal risk for patients since the blood samples for the TEG analysis were collected as part of routinely performed blood draws and no additional blood draws were performed, written consent was obtained from every patient.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding Sources Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by National High Level Hospital Clinical Research Funding (No. 2023-NHLHCRF-YYPPLC-ZR-12), the Elite Medical Professionals Project of China-Japan Friendship Hospital (No. ZRJY2023-QM29), and the China-Japan Friendship Hospital Self-selected Project (No. 2023-HX-46).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eAuthor ContributionsHuan Yang (First Author):\u0026nbsp;Conceptualization, design of the work, investigation, formal analysis, writing - original draft;Yusong Yuan:\u0026nbsp;Data Curation, methodology, software, formal analysis.Lei Shi:\u0026nbsp;the acquisition,Investigation,analysis.Yurun Yang:\u0026nbsp;the acquisition,Investigation,\u0026nbsp;Data Curation.Yidan Zhu*(Corresponding Author):the creation of new software used in the work, Interpretation of data.Ying Chen*(Corresponding Author):\u0026nbsp; Resources, Supervision, Writing - Review \u0026amp; Editing.All authors have approved the submitted version and have agreed both to be personally accountable for the author's own contributions and to ensure that questions related to the accuracy or integrity of any part of the work, even ones in which the author was not personally involved, are appropriately investigated, resolved, and the resolution documented in the literature.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eSequence data that support the findings of this study have been deposited in \"Figshare\" and could be asccessed via DOI:10.6084/m9.figshare.27159117\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLasocki S, Capdevila X, Vielle B, Bijok B, Lahlou-Casulli M, Collange V, Grillot N, Danguy des Deserts M, Duchalais A, Delannoy B, Drugeon B, Bouzat P, David JS, Rony L, Loupec T, Leger M, Rineau E, Hi FITI, network Sr. Ferric derisomaltose and tranexamic acid, combined or alone, for reducing blood transfusion in patients with hip fracture (the shift trial): A multicentre, 2 x 2 factorial, randomized, double-blind, controlled trial. \u003cem\u003eLancet Haematol\u003c/em\u003e. 2023;10:e747-e755\u003c/li\u003e\n\u003cli\u003eMiyamoto RG, Kaplan KM, Levine BR, Egol KA, Zuckerman JD. Surgical management of hip fractures: An evidence-based review of the literature. I: Femoral neck fractures. \u003cem\u003eJ Am Acad Orthop Surg\u003c/em\u003e. 2008;16:596-607\u003c/li\u003e\n\u003cli\u003eMeng H, Zhu Y, Zhang J, Li J, Zhao K, Zhang Y, Chen W. Incidence and a risk factor for preoperative deep vein thrombosis (DVT) in isolated calcaneal fracture, a prospective cohort study. \u003cem\u003eFoot Ankle Surg\u003c/em\u003e. 2021;27:510-514\u003c/li\u003e\n\u003cli\u003eWang PF, Li JH, Fei C, Li Z, Ke C, Shang K, Cong YX, Qu SW, Zhang BF, Zhuang Y, Zhang K. Deep vein thrombosis in the uninjured limb in patients with lower extremity fractures: A retrospective study. \u003cem\u003eBiomed Res Int\u003c/em\u003e. 2020;2020:1647617\u003c/li\u003e\n\u003cli\u003eSun Y, Chen D, Xu Z, Shi D, Dai J, Qin J, Jiang Q. Incidence of symptomatic and asymptomatic venous thromboembolism after elective knee arthroscopic surgery: A retrospective study with routinely applied venography. \u003cem\u003eArthroscopy\u003c/em\u003e. 2014;30:818-822\u003c/li\u003e\n\u003cli\u003eFallaha MA, Radha S, Patel S. Safety and efficacy of a new thromboprophylaxis regiment for total knee and total hip replacement: A retrospective cohort study in 265 patients. \u003cem\u003ePatient Saf Surg\u003c/em\u003e. 2018;12:22\u003c/li\u003e\n\u003cli\u003eGoh EL, Gurung PK, Ma S, Pilpel T, Dale JH, Kannan A, Anand S. Direct oral anticoagulants in the prevention of venous thromboembolism following surgery for hip fracture in older adults: A population-based cohort study. \u003cem\u003eGeriatr Orthop Surg Rehabil\u003c/em\u003e. 2020;11:2151459319897520\u003c/li\u003e\n\u003cli\u003eGong C, Yu K, Zhang N, Huang J. Predictive value of thromboelastography for postoperative lower extremity deep venous thrombosis in gastric cancer complicated with portal hypertension patients. \u003cem\u003eClin Exp Hypertens\u003c/em\u003e. 2021;43:196-202\u003c/li\u003e\n\u003cli\u003eSmith EB, Parvizi J, Purtill JJ. Delayed surgery for patients with femur and hip fractures risk of deep venous thrombosis. \u003cem\u003eJ Trauma\u003c/em\u003e. 2011;70:E113-116\u003c/li\u003e\n\u003cli\u003eKehlet H. Multimodal approach to control postoperative pathophysiology and rehabilitation. \u003cem\u003eBr J Anaesth\u003c/em\u003e. 1997;78:606-617\u003c/li\u003e\n\u003cli\u003eTantry US, Gurbel PA. Assessment of oral antithrombotic therapy by platelet function testing. \u003cem\u003eNat Rev Cardiol\u003c/em\u003e. 2011;8:572-579\u003c/li\u003e\n\u003cli\u003eTsantes AG, Papadopoulos DV, Trikoupis IG, Tsante KA, Mavrogenis AF, Koulouvaris P, Piovani D, Kriebardis AG, Gialeraki A, Nikolopoulos GK, Bonovas S, Papagelopoulos PJ, Tsantes AE. Rotational thromboelastometry findings are associated with symptomatic venous thromboembolic complications after hip fracture surgery. \u003cem\u003eClin Orthop Relat Res\u003c/em\u003e. 2021;479:2457-2467\u003c/li\u003e\n\u003cli\u003eBell SF, de Lloyd L, Preston N, Collins PW. Managing the coagulopathy of postpartum hemorrhage: An evolving role for viscoelastic hemostatic assays. \u003cem\u003eJ Thromb Hemost\u003c/em\u003e. 2023;21:2064-2077\u003c/li\u003e\n\u003cli\u003eYou D, Skeith L, Korley R, Cantle P, Lee A, McBeth P, McDonald B, Buckley R, Duffy P, Martin CR, Soo A, Schneider P. Identification of hypercoagulability with thrombelastography in patients with hip fracture receiving thromboprophylaxis. \u003cem\u003eCan J Surg\u003c/em\u003e. 2021;64:E324-E329\u003c/li\u003e\n\u003cli\u003eXu X, Jiang J, Liu W, Li X, Lu H. Application of thromboelastography to evaluate the effect of different routes administration of tranexamic acid on coagulation function in total hip arthroplasty. \u003cem\u003eJ Orthop Surg Res\u003c/em\u003e. 2019;14:430\u003c/li\u003e\n\u003cli\u003eMou Y, Li M, Hou S, Ren X, Tian B. Assessment of preoperative hypercoagulability in patients with pancreatic ductal adenocarcinoma (PDAC) using rapid thromboelastography (r-teg). \u003cem\u003eJ Thromb Thrombolysis\u003c/em\u003e. 2019;48:648-652\u003c/li\u003e\n\u003cli\u003eChang HW, Lee IO, Kang H, Won YJ, Lim YS. Coagulation effect of sugammadex as determined by thromboelastography in a randomized controlled study of surgical patients. \u003cem\u003eInt J Med Sci\u003c/em\u003e. 2021;18:1318-1324\u003c/li\u003e\n\u003cli\u003eFu YH, Liu P, Xu X, Wang PF, Shang K, Ke C, Fei C, Yang K, Zhang BF, Zhuang Y, Zhang K. Deep vein thrombosis in the lower extremities after femoral neck fracture: A retrospective observational study. \u003cem\u003eJ Orthop Surg (Hong Kong)\u003c/em\u003e. 2020;28:2309499019901172\u003c/li\u003e\n\u003cli\u003eNiikura T, Sakai Y, Lee SY, Iwakura T, Nishida K, Kuroda R, Kurosaka M. D-dimer levels to screen for venous thromboembolism in patients with fractures caused by high-energy injuries. \u003cem\u003eJ Orthop Sci\u003c/em\u003e. 2015;20:682-688\u003c/li\u003e\n\u003cli\u003eAbatzis-Papadopoulos M, Tigkiropoulos K, Nikas S, Papoutsis I, Kostopoulou O, Stavridis K, Karamanos D, Lazaridis I, Saratzis N. The effectiveness and safety of direct oral anticoagulants compared to conventional pharmacologic thromboprophylaxis in hip fracture patients: A systematic review and meta-analysis of randomized controlled trials. \u003cem\u003eOrthop Traumatol Surg Res\u003c/em\u003e. 2023;109:103364\u003c/li\u003e\n\u003cli\u003eHarder S, Graff J. Novel oral anticoagulants: Clinical pharmacology, indications and practical considerations. \u003cem\u003eEur J Clin Pharmacol\u003c/em\u003e. 2013;69:1617-1633\u003c/li\u003e\n\u003cli\u003eZeng X, Fang L, Peng Y, Zhang Y, Li X, Wang Z, Zhang B, Cao Q, Hu X. A multicenter reference interval study of thromboelastography in the Chinese adult population. \u003cem\u003eThromb Res\u003c/em\u003e. 2020;195:180-186\u003c/li\u003e\n\u003cli\u003eOlson JC. Thromboelastography-guided blood product use before invasive procedures in cirrhosis with severe coagulopathy: A randomized controlled trial. \u003cem\u003eClin Liver Dis (Hoboken)\u003c/em\u003e. 2019;13:102-105\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Hip fracture, elderly patients, TEG, DVT, combination","lastPublishedDoi":"10.21203/rs.3.rs-5198509/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5198509/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e \u003cp\u003eDeep 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.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e \u003cp\u003eWe 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.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e \u003cp\u003eThe 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\u0026thinsp;=\u0026thinsp;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\u0026thinsp;=\u0026thinsp;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\u0026thinsp;\u0026lt;\u0026thinsp;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\u0026thinsp;+\u0026thinsp;CI\u0026thinsp;+\u0026thinsp;αangle\u0026thinsp;+\u0026thinsp;D-dimer had the highest AUC (0.7475), followed by R\u0026thinsp;+\u0026thinsp;CI\u0026thinsp;+\u0026thinsp;αangle\u0026thinsp;+\u0026thinsp;BMI (0.7123). R\u0026thinsp;+\u0026thinsp;CI\u0026thinsp;+\u0026thinsp;αangle\u0026thinsp;+\u0026thinsp;gender had the lowest AUC (0.5920).\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e \u003cp\u003eTEG 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.\u003c/p\u003e","manuscriptTitle":"Enhanced diagnostic capabilities of thromboelastography coupled with standard coagulation indices for predicting perioperative thrombosis in older individuals with hip fractures","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-16 05:30:25","doi":"10.21203/rs.3.rs-5198509/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-04T19:58:10+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-11-18T21:46:02+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"34100129756571608155330295919755634283","date":"2024-11-10T20:45:40+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-10-14T08:01:22+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-04T00:25:55+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-04T00:01:29+00:00","index":"","fulltext":""},{"type":"submitted","content":"Journal of Orthopaedic Surgery and Research","date":"2024-10-03T13:01:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"journal-of-orthopaedic-surgery-and-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"josr","sideBox":"Learn more about [Journal of Orthopaedic Surgery and Research](http://josr-online.biomedcentral.com)","snPcode":"13018","submissionUrl":"https://submission.nature.com/new-submission/13018/3","title":"Journal of Orthopaedic Surgery and Research","twitterHandle":"@MSKmedBMC","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"0af7bd5e-32bf-4b81-83c4-e8e7c415002a","owner":[],"postedDate":"December 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2024-12-30T16:05:10+00:00","versionOfRecord":{"articleIdentity":"rs-5198509","link":"https://doi.org/10.1186/s13018-024-05386-4","journal":{"identity":"journal-of-orthopaedic-surgery-and-research","isVorOnly":false,"title":"Journal of Orthopaedic Surgery and Research"},"publishedOn":"2024-12-24 15:57:35","publishedOnDateReadable":"December 24th, 2024"},"versionCreatedAt":"2024-12-16 05:30:25","video":"","vorDoi":"10.1186/s13018-024-05386-4","vorDoiUrl":"https://doi.org/10.1186/s13018-024-05386-4","workflowStages":[]},"version":"v1","identity":"rs-5198509","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5198509","identity":"rs-5198509","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}