Evaluation of Viscoelastic Hemostatic Variations using Thromboelastography to Predict Thrombotic Complications following Major Pancreaticoduodenectomy

International Journal of Medicine and Medical Sciences | Vol. 16, No. 1, January 2026 | pp. 1–8

DOI: 10.46882/2026/IJMMS/160001

Original Research Article

Evaluation of Viscoelastic Hemostatic Variations using Thromboelastography to Predict Thrombotic Complications following Major Pancreaticoduodenectomy

Ibrahim K. Diallo¹, Victoria N. Eke², Jean-Baptiste M. Diop¹*

¹Department of Haematology, Faculté de Médecine, de Pharmacie et d'Odontologie, Université Cheikh Anta Diop, Dakar, Senegal.

²Department of Hematology and Blood Transfusion, College of Medicine, University of Lagos, Idi-Araba, Lagos, Nigeria.

Abstract:

Surgical interventions for periampullary malignancies trigger a profound hypercoagulable state, increasing the risk of deep vein thrombosis (DVT) and portal vein thrombosis. This prospective cohort study evaluated the performance of Thromboelastography (TEG) compared to conventional coagulation assays (CCA) for predicting postoperative venous thromboembolism (VTE) following major pancreaticoduodenectomy. We evaluated 110 adult patients undergoing elective Whipple procedures. Baseline and postoperative day 3 TEG parameters (reaction time [R], maximum amplitude [MA], and coagulation index [CI]) and CCA profiles (D-dimer, fibrinogen, and prothrombin time) were tracked, and lower limb duplex ultrasonography screening was performed on postoperative day 7. Within 14 days post-surgery, VTE was confirmed in 16.4% (18/110) of the patients. In the thrombotic cohort, postoperative day 3 TEG profiles demonstrated a marked hypercoagulable state, characterized by a significantly shortened R-time (3.12 ± 0.42 minutes vs. 5.65 ± 0.84 minutes in non-VTE patients, p < 0.001) and an elevated MA value (74.38 ± 4.52 mm vs. 61.24 ± 3.18 mm, p < 0.001). Preoperative CCA values did not show significant predictive power between groups (p > 0.05). Receiver Operating Characteristic (ROC) analysis showed that a day 3 TEG MA cutoff value > 70 mm predicted VTE development with a sensitivity of 88.9%, a specificity of 83.7%, and an Area Under the Curve (AUC) of 0.91 (95% CI = 0.84–0.96). Viscoelastic monitoring via TEG provides superior prediction of postoperative thrombotic risks following pancreatic surgery compared to standard testing, serving as an effective tool to guide extended chemical thromboprophylaxis protocols.

Keywords: Thromboelastography, Pancreaticoduodenectomy, Venous Thromboembolism, Hypercoagulability, Maximum Amplitude, Thromboprophylaxis

Manuscript Timeline: Received: October 12, 2025; Revised: November 20, 2025; Accepted: December 14, 2025; Published: January 14, 2026.

Citation: Diallo IK, Eke VN, Diop JBM. Evaluation of Viscoelastic Hemostatic Variations using Thromboelastography to Predict Thrombotic Complications following Major Pancreaticoduodenectomy. International Journal of Medicine and Medical Sciences, 2026, 16(1): 1–8. DOI: 10.46882/2026/IJMMS/160001

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