Evaluation of changes in coagulation profile by thromboelastography in patients undergoing lobectomy for malignancy

Background: Thromboelastography (TEG) provides a global assessment of coagulation and fibrinolytic activity. This study aimed to evaluate postoperative coagulation changes in patients undergoing lobectomy for lung malignancy using TEG. Methods: In this prospective observational study, sixteen patients undergoing lobectomy for lung malignancy were included. TEG analyses were performed preoperatively, on postoperative day 0 (POD0) before low-molecular-weight heparin (LMWH) initiation, and on postoperative day 3 (POD3) after initiation of routine LMWH thromboprophylaxis. r time (clot initiation), k time (clot kinetics), α-angle (rate of clot strengthening), maximum amplitude (MA; maximum clot strength), Ly30 (fibrinolytic activity), and coagulation index (CI; overall coagulability) were evaluated. Temporal changes were analyzed using linear mixed models with Bonferroni-adjusted pairwise comparisons (Clinical trial registration: ClinicalTrials.gov identifier: NCT06484231). Results: No significant temporal change was observed in r time (p=0.293). Significant changes were detected in k time, α-angle, MA, Ly30, and CI (all p<0.001). On POD0, k time was prolonged and MA decreased compared with preoperative values, whereas α-angle increased and Ly30 showed a decreasing tendency, indicating heterogeneous postoperative coagulation responses. On POD3, α-angle significantly decreased compared with POD0, while Ly30 significantly increased compared with both preoperative values and POD0, suggesting evolving coagulation dynamics under ongoing thromboprophylaxis. CI progressively increased throughout the postoperative period, indicating a shift toward a more hypercoagulable profile. Conclusion: TEG revealed a dynamic, multidimensional postoperative coagulation profile rather than a uniform hypercoagulable shift. Early (POD0) changes-prolonged k time and reduced MA with an increased α-angle-likely reflected surgical trauma and perioperative hemodilution, whereas POD3 findings appeared to combine physiological recovery with thromboprophylaxis. The progressive rise in CI indicated an evolving shift toward hypercoagulability, while α-angle and Ly30 emerged as the most responsive parameters and may be useful for monitoring perioperative coagulation. Because postoperative recovery and LMWH effects could not be disentangled in this design, these findings are hypothesis-generating and warrant confirmation in larger controlled studies.