Usefulness of thromboelastography in predicting hypercoagulability in patients undergoing free tissue transfer
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Reconstructive microvascular surgery is performed on over 5 million patients in the United States each year. Important sub-populations are patients with breast cancer and trauma to their lower extremities, which affects over 120,000 patients. While data has demonstrated that the failure rates for these free tissue transfers as a result of vascular clot formation is limited, there lacks a mechanism to predict the chances of such failures. Such complications increase hospital length of stay and health care costs. The aim of the study was to demonstrate the efficacy of using Thromboelastography (TEG) as a point-of-care test in order to identify hypercoagulable patients, monitor coagulability changes over the course of free flap reconstruction, and ultimately use this data to predict post-operative microvascular compromise. Following IRB approval, we attempted to recruit both lower extremity trauma patients (N=5) and patients with active breast cancer (N=5) undergoing free flap reconstruction. Blood was collected pre-operatively and intra-operatively, at the time of anastomosis. Standard and Heparinase TEG were performed on each sample within 2 hours of collection. We were unable to recruit patients from the trauma population but did identify 5 breast cancer patients. Hypercoagulability was defined as having low R and high α-angle values (p = 0.04 and 0.02, respectively), in the presence or absence of high MA and low R-values. Based on this definition, 80% of patients were found to become hypercoagulable over the course of the surgical procedure. While no patients experienced post-operative microvascular complications. As a result, we discovered that TEG has the ability to identify hypercoagulability and that over the course of a free flap reconstruction, breast cancer patients are likely to become more hypercoagulable when compared to baseline values. Following the recruitment of more patients, TEG could potentially be a useful supplemental tool in microvascular surgery in order to monitor coagulability changes and ultimately be used to predict post-operative thrombotic complications.