Usage of Thromboelastography With Platelet Mapping Assay to Predict Graft Thrombosis in Lower Extremity Revascularization

Hypercoagulability is one of the most commonly implicated causes of graft and stent thrombosis, and the current strategies for prevention after revascularization have relied on antiplatelet and anticoagulation medication. Existing coagulation tests might not reflect in vivo coagulation and do not measure parameters such as platelet function. The use of thromboelastography with platelet mapping (TEG-PM) aims to assay the clot strength with consideration of inherent platelet resistance to medications and might provide an integral key to the next stage of patient-centered, personalized thromboprophylaxis. The present prospective observational study aimed to determine whether TEG-PM could identify patients who were more likely to experience thrombotic events after extremity revascularization. All patients undergoing named vessel revascularization from December 2020 to August 2021 at a large tertiary institution were prospectively included. The patients had undergone TEG-PM assays immediately preoperatively and at serial intervals postoperatively for ≤6 months. A total of 58 patients had met the enrollment criteria and were included in the present analysis. Of the 58 patients, 10 (17.2%) had experienced thrombosis of their graft or stent that had required reintervention and/or amputation. The TEG-PM results at the point just before the thrombotic event were compared with results from the “last known well visit” in the nonevent group. Platelet aggregation was significantly higher in the thrombotic event group compared with that in the nonevent group (80.3% ± 22.2% vs 63.1% ± 22.7%; P < .05; Fig, A). The percentage of platelet inhibition was significantly lower in the thrombotic event group than that in the nonevent group (19.7% ± 22.2% vs 35.9% ± 23.1%; P < .05; Fig, B). Other TEG-PM values reflecting the time to clot formation, strength, and breakdown did not differ. No significant difference was found in the proportion of patients taking antiplatelet or anticoagulation medications nor in the routine coagulation study values between the two groups. TEG-PM revealed a significantly higher level of platelet aggregation with diminished platelet inhibition before thrombotic events in postrevascularization patients. Thromboprophylaxis and the results from traditional coagulation studies did not differ significantly between the two groups. Our results have indicated that current antiplatelet and anticoagulant management might be insufficient in protecting patients from thrombosis of their graft or stent. TEG-PM could be useful in identifying those at risk of thrombosis and establishing the role of personalized medicine in peripheral vascular surgery.