Higher coagulation activity in hip fracture patients: A case-control study using rotational thromboelastometry.

Area of Science:

• Orthopedic Surgery
• Trauma Medicine
• Hemostasis and Thrombosis

Background:

• Trauma-induced coagulopathy is well-studied in severe trauma but less so in moderate orthopedic injuries.
• Hip fractures represent a common orthopedic trauma with potential hemostatic implications.

Purpose of the Study:

• To evaluate hemostatic profile changes in hip fracture patients using rotational thromboelastometry (ROTEM).
• To compare coagulation parameters between hip fracture patients and healthy individuals.
• To assess the impact of surgical treatment on coagulation in hip fracture patients.

Main Methods:

• Included 198 patients with hip fractures undergoing surgery and 52 healthy controls.
• Recorded demographics, conventional coagulation assays, and ROTEM parameters.
• Compared ROTEM values preoperatively and postoperatively in fractured patients.

Main Results:

• ROTEM revealed significantly higher coagulation potential in hip fracture patients compared to controls, despite similar conventional assays.
• Fractured patients exhibited altered ROTEM parameters (e.g., lower CT, CFT; higher MCF, A10, alpha angle).
• Surgery further increased coagulation activity, indicated by decreased INTEM CT/CFT and increased INTEM MCF/A10/alpha angle postoperatively.

Conclusions:

• Rotational thromboelastometry (ROTEM) detects heightened coagulation activity following hip fractures shortly after injury.
• This hypercoagulable state may be missed by conventional coagulation tests.
• Surgical intervention exacerbates the procoagulant changes in hip fracture patients.