Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data
Background Peripheral artery disease is endemic in our globally aging population, with >200 million affected worldwide. Graft/stent thrombosis after revascularization is common and frequently results in amputation, major adverse cardiovascular events, and cardiovascular mortality. Optimizing medi...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Wiley
2023-01-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.122.027790 |
| _version_ | 1797905075355516928 |
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| author | Monica Majumdar Ryan P. Hall Zachary Feldman Guillaume Goudot Natalie Sumetsky Samuel Jessula Amanda Kirshkaln Tiffany Bellomo David Chang Jessica Cardenas Rushad Patell Matthew Eagleton Anahita Dua |
| author_facet | Monica Majumdar Ryan P. Hall Zachary Feldman Guillaume Goudot Natalie Sumetsky Samuel Jessula Amanda Kirshkaln Tiffany Bellomo David Chang Jessica Cardenas Rushad Patell Matthew Eagleton Anahita Dua |
| author_sort | Monica Majumdar |
| collection | DOAJ |
| description | Background Peripheral artery disease is endemic in our globally aging population, with >200 million affected worldwide. Graft/stent thrombosis after revascularization is common and frequently results in amputation, major adverse cardiovascular events, and cardiovascular mortality. Optimizing medications to decrease thrombosis is of paramount importance; however, limited guidance exists on how to use and monitor antithrombotic therapy in this heterogeneous population. Thromboelastography with platelet mapping (TEG‐PM) provides comprehensive coagulation metrics and may be integral to the next stage of patient‐centered thrombophrophylaxis. This prospective study aimed to determine if TEG‐PM could predict subacute graft/stent thrombosis following lower extremity revascularization, and if objective cut point values could be established to identify those high‐risk patients. Methods and Results We conducted a single‐center prospective observational study of patients undergoing lower extremity revascularization. Patients were followed up for the composite end point postoperative graft/stent thrombosis at 1 year. TEG‐PM analysis of the time point before thrombosis in the event group was compared with the last postoperative visit in the nonevent group. Cox proportional hazards analysis examined the association of TEG‐PM metrics to thrombosis. Cut point analysis explored the predictive capacity of TEG‐PM metrics for those at high risk. A total of 162 patients were analyzed, of whom 30 (18.5%) experienced graft/stent thrombosis. Patients with thrombosis had significantly greater platelet aggregation (79.7±15.7 versus 58.5±26.4) and lower platelet inhibition (20.7±15.6% versus 41.1±26.6%) (all P<0.01). Cox proportional hazards analysis revealed that for every 1% increase in platelet aggregation, the hazard of experiencing an event during the study period increased by 5% (hazard ratio, 1.05 [95% CI, 1.02–1.07]; P<0.01). An optimal cut point of >70.8% platelet aggregation and/or <29.2% platelet inhibition identifies those at high risk of thrombosis with 87% sensitivity and 70% to 71% specificity. Conclusions Among patients undergoing lower extremity revascularization, increased platelet reactivity was predictive of subacute postoperative graft/stent thrombosis. On the basis of the cut points of >70.8% platelet aggregation and <29.2% platelet inhibition, consideration of an alternative or augmented antithrombotic regimen for high‐risk patients may decrease the risk of postoperative thrombotic events. |
| first_indexed | 2024-04-10T09:59:16Z |
| format | Article |
| id | doaj.art-cbaf29404db84375a92399412ba60f50 |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-10T09:59:16Z |
| publishDate | 2023-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-cbaf29404db84375a92399412ba60f502023-02-16T10:55:33ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-01-0112110.1161/JAHA.122.027790Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic DataMonica Majumdar0Ryan P. Hall1Zachary Feldman2Guillaume Goudot3Natalie Sumetsky4Samuel Jessula5Amanda Kirshkaln6Tiffany Bellomo7David Chang8Jessica Cardenas9Rushad Patell10Matthew Eagleton11Anahita Dua12Division of Vascular and Endovascular Surgery, Department of Surgery Massachusetts General Hospital/Harvard Medical School Boston MADivision of Vascular and Endovascular Surgery, Department of Surgery Massachusetts General Hospital/Harvard Medical School Boston MADivision of Vascular and Endovascular Surgery, Department of Surgery Massachusetts General Hospital/Harvard Medical School Boston MACardiovascular Research Center, Division of Cardiology Massachusetts General Hospital/Harvard Medical School Boston MADepartment of Epidemiology and Statistics University of Pittsburg PADivision of Vascular and Endovascular Surgery, Department of Surgery Massachusetts General Hospital/Harvard Medical School Boston MADivision of Vascular and Endovascular Surgery, Department of Surgery Massachusetts General Hospital/Harvard Medical School Boston MADivision of Vascular and Endovascular Surgery, Department of Surgery Massachusetts General Hospital/Harvard Medical School Boston MAHealthcare Research and Policy Development, Codman Center, Department of Surgery Massachusetts General Hospital/Harvard Medical School Boston MACenter for Translational Injury Research University of Texas–Houston Houston TXDivision of Hematology/Oncology Beth Israel Deaconess Medical Center/Harvard Medical School Boston MADivision of Vascular and Endovascular Surgery, Department of Surgery Massachusetts General Hospital/Harvard Medical School Boston MADivision of Vascular and Endovascular Surgery, Department of Surgery Massachusetts General Hospital/Harvard Medical School Boston MABackground Peripheral artery disease is endemic in our globally aging population, with >200 million affected worldwide. Graft/stent thrombosis after revascularization is common and frequently results in amputation, major adverse cardiovascular events, and cardiovascular mortality. Optimizing medications to decrease thrombosis is of paramount importance; however, limited guidance exists on how to use and monitor antithrombotic therapy in this heterogeneous population. Thromboelastography with platelet mapping (TEG‐PM) provides comprehensive coagulation metrics and may be integral to the next stage of patient‐centered thrombophrophylaxis. This prospective study aimed to determine if TEG‐PM could predict subacute graft/stent thrombosis following lower extremity revascularization, and if objective cut point values could be established to identify those high‐risk patients. Methods and Results We conducted a single‐center prospective observational study of patients undergoing lower extremity revascularization. Patients were followed up for the composite end point postoperative graft/stent thrombosis at 1 year. TEG‐PM analysis of the time point before thrombosis in the event group was compared with the last postoperative visit in the nonevent group. Cox proportional hazards analysis examined the association of TEG‐PM metrics to thrombosis. Cut point analysis explored the predictive capacity of TEG‐PM metrics for those at high risk. A total of 162 patients were analyzed, of whom 30 (18.5%) experienced graft/stent thrombosis. Patients with thrombosis had significantly greater platelet aggregation (79.7±15.7 versus 58.5±26.4) and lower platelet inhibition (20.7±15.6% versus 41.1±26.6%) (all P<0.01). Cox proportional hazards analysis revealed that for every 1% increase in platelet aggregation, the hazard of experiencing an event during the study period increased by 5% (hazard ratio, 1.05 [95% CI, 1.02–1.07]; P<0.01). An optimal cut point of >70.8% platelet aggregation and/or <29.2% platelet inhibition identifies those at high risk of thrombosis with 87% sensitivity and 70% to 71% specificity. Conclusions Among patients undergoing lower extremity revascularization, increased platelet reactivity was predictive of subacute postoperative graft/stent thrombosis. On the basis of the cut points of >70.8% platelet aggregation and <29.2% platelet inhibition, consideration of an alternative or augmented antithrombotic regimen for high‐risk patients may decrease the risk of postoperative thrombotic events.https://www.ahajournals.org/doi/10.1161/JAHA.122.027790graft thrombosisperipheral artery diseasepersonalized medicineplatelet aggregationthromboelastographythromboprophylaxis |
| spellingShingle | Monica Majumdar Ryan P. Hall Zachary Feldman Guillaume Goudot Natalie Sumetsky Samuel Jessula Amanda Kirshkaln Tiffany Bellomo David Chang Jessica Cardenas Rushad Patell Matthew Eagleton Anahita Dua Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease graft thrombosis peripheral artery disease personalized medicine platelet aggregation thromboelastography thromboprophylaxis |
| title | Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data |
| title_full | Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data |
| title_fullStr | Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data |
| title_full_unstemmed | Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data |
| title_short | Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data |
| title_sort | predicting arterial thrombotic events following peripheral revascularization using objective viscoelastic data |
| topic | graft thrombosis peripheral artery disease personalized medicine platelet aggregation thromboelastography thromboprophylaxis |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.122.027790 |
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