Thromboelastography-based dynamic evaluation of perioperative coagulation changes and anticoagulant efficacy in lung cancer patients.

Background: Venous thromboembolism (VTE) is a common postoperative complication in oncologic surgery, closely associated with perioperative hypercoagulability. Thromboelastography (TEG) may be an effective method for monitoring hypercoagulability and guiding preventive anticoagulation.

Methods: We prospectively collected perioperative clinical data from lung cancer surgery patients at our hospital between June 2019 and January 2020. TEG and coagulation-related indicators were monitored preoperatively, and on postoperative days 1 and 3. Newly diagnosed postoperative VTE was monitored using lower limb color doppler ultrasound.

Results: A total of 241 lung cancer surgery patients were included, with 25 developing VTE postoperatively (10.4%). TEG results showed a significant decrease in the R value (a thrombin marker) on postoperative day 1, followed by an increase on day 3. The MA value (a platelet marker) increased postoperatively. D-dimer levels also rose after surgery. On postoperative day 1, thrombin-related hypercoagulability was predominant (15/17 preoperatively, 40/46 postoperatively), whereas platelet-related hypercoagulability was dominant on postoperative day 3 (18/35). Patients who received prophylactic anticoagulation had significantly higher R values on day 3. The ROC curve for D-dimer predicting new-onset VTE showed AUCs of 0.732, 0.790, and 0.847 preoperatively, on days 1, and 3, respectively.

Conclusion: D-dimer helps identify high-risk patients for postoperative VTE, while TEG aids in classifying and monitoring hypercoagulability, optimizing anticoagulation therapy choices and dosages.