Predictive value of thromboelasmogram for deep venous thrombosis in elderly patients with severe disease

doi:10.3877/cma.j.issn.2095-8757.2020.03.002

Abstract

Abstract:

Objective

To the predictive value of TEG for formation of Deep vein thrombosis (DVT) in elderly patients with severe thrombelastogram.

Methods

59 elderly critically patients admitted to Jiaxing First Hospital from February 2017 to May 2018 were selected, venous blood samples were collected on the 1st, 3rd, 5th and 7th day after admission, and the results of TEG and CCT were recorded. TEG and CCT indexes were compared between DVT group and non DVT group by T-test/rank sum test or chi-square test. ROC curve was used to evaluate the predictive value of TEG and CCT for DVT in elderly patients with severe diseases.

Results

The results of CCT showed that the difference of D-dimer (D-D) level between DVT group and non DVT group was statistically significant (t=2.345, P < 0.05); the results of TEG test showed that the formation speed, maximum amplitude and coagulation index of DVT group were significantly higher than those of non DVT group (t=2.151, 2.614; F=13.750; P < 0.05); and the maximum amplitude difference between the two groups was statistically significant only on the 5th day after admission (P < 0.05). According to the ROC curve analysis results, the indicators that are good at predicting the value of DVT clinically include maximum amplitude, agglutination velocity, coagulation index and D-D, the sensitivity is 94.4%, 50.0%, 44.4% and 95.1%, specificity is 48.8%, 85.4%, 85.4% and 33.3%, respectively, and area under the ROC curve is 0.762, 0.662, 0.656 and 0.651, respectively. Ma was 67.5 on the 5th day after admission into ICU, which was the best clinical diagnostic cut-off value for DVT.

Conclusion

The accuracy of TEG in predicting DVT in elderly critically patients was higher than that of CCT.

Key words: Thrombelastogram, Conventional coagulation test, Aged, Critically ill, Deep vein thrombosis

Peng Shen, Qianqian Wang, Yichen Gu, Liangxiao Dai, Lijin Wu, Yunchao Shi. Predictive value of thromboelasmogram for deep venous thrombosis in elderly patients with severe disease[J]. Chinese Journal of Geriatrics Research(Electronic Edition), 2020, 07(03): 7-11.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhlnbyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-8757.2020.03.002

https://zhlnbyjdzzz.cma-cmc.com.cn/EN/Y2020/V07/I03/7

Figures/Tables 5

References 20

[1]	Jie-Qiong S, Li-Zhen X, Wei W，et al. Low molecular weight heparin once versus twice for thromboprophylaxis following esophagectomy: a randomised, double-blind and placebo-controlled trial[J]. J Thoracic Disease, 2015, 7(7):1158-1164.
[2]	Macafee B, Campbell JP, Ashpole K, et al. Reference ranges for thromboelastography (TEG((R))) and traditional coagulation tests in term parturients undergoing caesarean section under spinal anaesthesia[J]. Anaesthesia, 2012, 67(7):741-747.
[3]	Brill JB, Badiee J, Zander AL, et al. The rate of deep vein thrombosis doubles in trauma patients with hypercoagulable thromboelastography[J]. J Trauma Acute Care Surgery, 2017, 83(3):413-419.
[4]	Alexander MJ, Lombard FW, Borel C, et al. Clinical use of thromboelastography to determine risk of thromboembolus in cerebral aneurysm embolization[J]. J Neurosurgery, 2004, 100:A199.
[5]	Kashuk JL, Moore EE, Sabel A, et al. Rapid thrombelastography (r-TEG) identifies hypercoagulability and predicts thromboembolic events in surgical patients[J]. Surgery, 2009, 146(4):764-772.
[6]	Van PY, Cho SD, Underwood SJ, et al. Thrombelastography versus AntiFactor Xa levels in the assessment of prophylactic-dose enoxaparin in critically ill patients[J]. J Trauma, 2009, 66(6):1509-1515.
[7]	Park MS, Martini WZ, Dubick MA, et al. Thromboelastography as a better indicator of hypercoagulable state after injury than prothrombin time or activated partial thromboplastin time[J]. J Trauma, 2009, 67(2):266-275.
[8]	Wilson D, Cooke EA, Mcnally MA, et al. Changes in coagulability as measured by thrombelastography following surgery for proximal femoral fracture[J]. Injury, 2001, 32(10):765-770.
[9]	张建英，徐冉行，姚亚萍，等.ROC曲线确定D-二聚体诊断骨科患者深静脉血栓的截断点[J].中国现代医生，2012，50（12）：61-63.
[10]	吴红军，李荣霞，李毅，等.重症急性胰腺炎血浆D-二聚体变化的临床研究[J].中国危重病急救医学，2012，24（11）：658-661.
[11]	Hass FJ, Schutgens RE, Biesma DH. An age-adapted approach for the use of D-dimers in the exclusion of deep venous thrombosis[J]. Am J Hematol, 2009, 84(8):488-491.
[12]	钟声健，张春宝，胡军涛，等.血栓弹力图评价脓毒症患者的凝血功能障碍[J].中华危重病急救医学，2016，28（2）：153-158.
[13]	Reikvam H, Steien E, Hauge B, et al. Thrombelastography[J].Transfus Apher Sci, 2009, 40(2):119-123.
[14]	De Pietri L, Montalti R, Begliomini B, et al. Thromboelastographic changes in liver and pancreatic cancer surgery: hypercoagulability, hypocoagulability or normocoagulability[J]? Eur J Anaesthesiol, 2010, 27(7):608-616.
[15]	孙振朕，朱科明，邓小明.血小板和中性粒细胞在脓毒症中作用机制的研究进展[J].中国危重病急救医学，2011，23（8）：502-504.
[16]	向琪. 血小板在脓毒症中的研究进展[J].血栓与止血学，2013，19（1）：44-45.
[17]	Hobson AR, Agarwala RA, Swallow RA, et al. Thrombelastography: current clinical applications and its potential role in interventional cardiology[J]. Platelets, 2006, 17(8):509-518.
[18]	Yao X, Dong Q, Song Y, et al. Thrombelastography maximal clot strength could predict one-year functional outcome in patients with ischemic stroke[J]. Cerebrovasc Dis, 2014, 38(3):182-190.
[19]	Rafiq S, Johansson PI, Ostrowski SR, et al. Hypercoagulability in patients undergoing coronary artery bypass grafting:prevalence, patient characteristics and postoperative outcome[J]. Eur J Cardiothorac Surg, 2012, 41(3):550-555.
[20]	McCrath DJ, Cerboni E, Frumento RJ, et al. Thromboelastography maximum amplitude predicts postoperative thrombotic complications including myocardial infarction[J]. Anesth Analg, 2005, 100(6):1576-1583.

组别	例数	性别（男/女，例）	年龄（岁）	APACHEⅡ（分）	合并症及既往史（男/女，例）
组别	例数	性别（男/女，例）	年龄（岁）	APACHEⅡ（分）	肾功能不全	心功能不全	糖尿病	恶性肿瘤史	近期手术史
DVT组	18	11/7	73.6±6.9	16.9±4.6	9/9	5/13	5/13	2/16	4/14
非DVT组	41	26/15	73.7±9.1	16.9±4.2	19/22	14/27	11/30	6/35	13/28
检验值		χ²=0.819	t=0.947	t=0.979	χ²=0.740	χ²=0.678	χ²=0.901	χ²=0.745	χ²=0.500
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	性别（男/女，例）	年龄（岁）	APACHEⅡ（分）	合并症及既往史（男/女，例）
组别	例数	性别（男/女，例）	年龄（岁）	APACHEⅡ（分）	肾功能不全	心功能不全	糖尿病	恶性肿瘤史	近期手术史
DVT组	18	11/7	73.6±6.9	16.9±4.6	9/9	5/13	5/13	2/16	4/14
非DVT组	41	26/15	73.7±9.1	16.9±4.2	19/22	14/27	11/30	6/35	13/28
检验值		χ²=0.819	t=0.947	t=0.979	χ²=0.740	χ²=0.678	χ²=0.901	χ²=0.745	χ²=0.500
P值		>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05	>0.05

组别	例数	PT（s）	APTT（s）	INR	D-二聚体（ng/ml）
DVT组	18	15.44±2.39	44.44±9.30	1.25±0.25	12 505.50±948.35
非DVT组	41	15.39±1.95	43.25±7.47	1.24±0.20	6 830.49±731.94
t值		0.084	0.481	0.099	2.345
P值		>0.05	>0.05	>0.05	<0.05

组别	例数	PT（s）	APTT（s）	INR	D-二聚体（ng/ml）
DVT组	18	15.44±2.39	44.44±9.30	1.25±0.25	12 505.50±948.35
非DVT组	41	15.39±1.95	43.25±7.47	1.24±0.20	6 830.49±731.94
t值		0.084	0.481	0.099	2.345
P值		>0.05	>0.05	>0.05	<0.05

指标		DVT组（n=18）	非DVT组（n=41）	检验值	P值
反应时间（min）		8.16±2.45	8.39±2.56	t=-0.372	>0.05
凝集时间（min）		2.72（1.23，2.48）	2.83（1.30，2.51）	Z=-1.734	>0.05
凝集块形成速度（deg）		68.36±10.87	61.53±11.98	t=2.151	<0.05
综合凝血指数		-2.15（-2.93，1.28）	-2.27（-2.78，1.65）	Z=-2.324	<0.05
最大振幅（mm）				F=13.750	<0.05
	第1天	68.21±11.83	64.72±14.66	-	>0.05
	第3天	63.72±13.49	66.17±13.79	-	>0.05
	第5天	75.56±5.95	60.35±29.59	-	<0.05
	第7天	71.71±10.65	65.30±11.91	-	>0.05

Please choose a citation manager

Content to export