VPB0469 - Pulmonary cement embolism after kyphoplasty: Clinical and Laboratory aspects of pro-coagulant effects

Sunday, July 10, 2022

6:30 PM – 7:30 PM

Location: Exhibition

Presentation Format: Virtual

Presenting Author(s)

VM

Viktoria Muster, Dr

Resident physician
Medical University of Graz
Graz, Steiermark, Austria

Co-Author(s)

PJ

Philip Jud

Consultant physician
Medical University Graz
Graz, Steiermark, Austria
KG

Katharina Gütl

Consultant physician
Medical University Graz
Graz, Steiermark, Austria
Fp

Florian prüller

Professor
Medical University Graz
Graz, Steiermark, Austria
LS

Leyla Schweiger

Consultant Physician
Medical University Graz
Graz, Steiermark, Austria
TG

Thomas Gary

Professor
Medical University Graz
Graz, Steiermark, Austria
MB

Marianne Brodmann

Professor
Medical University Graz
Graz, Steiermark, Austria
Rr

Reinhard raggam

Consultant Physician
Medical University Graz
Graz, Steiermark, Austria

Background: PMMA is most commonly used in kyphoplasty. During injection, migration of cement-particles and hence embolization in the venous circulation system can occur. A cement PE is therefore a potential complication.

Aims: We present a case of a 65-yo female with cement PE after kyphoplasty. Ex-vivo plasmatic coagulation studies using PMMA with hydroxylapatit were performed.

Methods: A solution with sterile water and PMMA in a concentration of 0.5g/ml was made and 0, 25, 100 and 250µl were added to the citrated kaolin test and measured with a thrombelastogram.

Results: A 65-yo woman presented three days after kyphoplasty with dyspnea, chest pain and swelling in the right calf. CTPA was performed revealing cement PE. Compression ultra sound confirmed a deep vein thrombosis. Enoxaparin 80 mg b.i.d. was started and was switched to edoxaban 60mg once daily after 5 days.
The citrated kaolin test analyzed with the thrombelastogram showed a R-time of 330 sec., 295 sec., 250 sec. 215 sec. for 0, 25, 100 and 250 µl of the solution added, respectively. With increasing quantity of the cement powder solution, a faster clot formation is present. The reduction of the R time measured between no cement powder solution and 250yl of cement powder solution added to the citrated kaolin test is 34.9%.

Conclusion(s): In our study we found a reduction of the R time in the thrombelastogram with increasing quantity of bone cement showing that a coagulation activation is happening and a clot is formatted in a shorter time. Previous studies could not show this effect. With the results of our study we support that anticoagulation should be started in case of cement PE.