Study on the synergistic monitoring of thromboelastography and conventional coagulation tests during the perioperative period in fracture patients and optimization of VTE prediction

To evaluate the predictive value of synergistic monitoring using thromboelastography (TEG) and conventional coagulation tests (CCTs) for postoperative venous thromboembolism (VTE) in fracture patients. A total of 596 surgically treated fracture patients were retrospectively analyzed and divided into a VTE group ( n = 207) and a non-VTE group ( n = 389) based on the occurrence of VTE within 30 days postoperatively. CCTs, including prothrombin time, activated partial thromboplastin time, thrombin time, and fibrinogen (FIB), and TEG parameters (reaction time-R, kinetics-K, alpha angle-α, maximum amplitude-MA) were measured preoperatively and on postoperative days 1, 3, and 7. The VTE group had significantly older age (60.45 vs. 56.18 years), higher body mass index (26.03 vs. 25.16 kg/m²), higher prevalence of diabetes mellitus (25.60% vs. 16.71%), longer operation time (135.29 vs. 122.58 min), greater intraoperative blood loss (334.13 vs. 315.72 mL), and higher rate of intraoperative blood transfusion (36.23% vs. 25.19%). They also exhibited consistently higher FIB levels, α angle, and MA values at multiple perioperative time points (all P < 0.05), and a greater proportion were in a TEG-defined hypercoagulable state (e.g., 63.29% vs. 34.70% on day 1). Multivariate analysis identified postoperative day 1 FIB, α angle, and MA as independent risk factors. A combined predictive model integrating these factors achieved an area under the curve of 0.852, superior to any single parameter. Synergistic perioperative monitoring with TEG and CCTs provides optimized prediction of VTE in fracture patients, with a combined model offering discriminatory power. Not applicable.