Assessment of Hypercoagulability After Orthopedic Trauma Surgery Using Coagulation Biomarkers and TEG/ROTEM

Orthopedic trauma surgery is associated with an increased risk of postoperative hypercoagulability, predisposing patients to potentially life-threatening thromboembolic complications, including deep vein thrombosis (DVT) and pulmonary embolism (PE). Conventional coagulation tests, including prothrombin time (PT), activated partial thromboplastin time (aPTT), and international normalized ratio (INR), have limited sensitivity in detecting the complex hemostatic alterations that occur following orthopedic trauma procedures. In recent years, viscoelastic hemostatic assays—thromboelastography (TEG) and rotational thromboelastometry (ROTEM)—alongside specific coagulation biomarkers, such as D-dimer, fibrinogen, thrombin–antithrombin (TAT) complexes, and prothrombin fragments F1+2, have emerged as promising tools for a more comprehensive assessment of coagulation status in the perioperative setting. This narrative review, conducted using a structured literature search strategy with systematic elements, aims to synthesize the current evidence regarding the use of TEG/ROTEM and coagulation biomarkers in evaluating hypercoagulability following orthopedic trauma surgery, identify patterns of hemostatic dysregulation across different surgical procedures and patient populations, and highlight existing gaps in the literature. A structured search was conducted across major electronic databases, including PubMed, Scopus, Web of Science, Embase, and the Cochrane Library. The findings of this review provide clinicians with a clearer framework for perioperative coagulation monitoring and inform future research aimed at optimizing individualized thromboprophylaxis strategies in orthopedic trauma patients.