BACKGROUND: There is a high incidence of thromboembolism after major orthopedic surgery. However, more perioperative thromboembolic complications are expected after orthopedic surgery in geriatric patients due to the more offensive therapeutic measures and the increasing number of such patients with multimorbidity. Therefore it is important to investigate the perioperative blood coagulation status in detail.

METHODS: Forty-five patients who were over 65 years old and scheduled for major orthopedic surgery were enrolled in this study. Patients with preoperative coagulation abnormalities, or receiving anticoagulants or antiplatelet medications were excluded. Preoperative thromboelastography (TEG), intraoperative TEG after blood loss equaling approximately 10% of the estimated blood volume, and postoperative TEG at the recovery room were measured and compared.

RESULTS: During the operation, the R time and coagulation time (r + k) showed significant decreases, whereas the alpha angle, maximum amplitude (MA) and TEG index increased significantly (P < 0.05), indicating increased coagulability. The A60, CL30 and CL60 also increased, indicating decreased fibrinolysis (P < 0.05). These hypercoagulable findings were relieved after surgery to levels similar to those observed preoperatively.

CONCLUSIONS: The intraoperative coagulability increased compared with the preoperative and postoperative period according to the TEG. This means that the intraoperative period is the period of most susceptibility to thromboembolic complications.