Cardiovascular
Title: Titrating Antiplatelet Regimens in Peripheral Artery Disease Post-Revascularization Using Thromboelastography-Platelet Mapping (TEG-PM) Parameters: Adenosine Diphosphate Maximum Amplitude(ADP MA) and Arachnoid Acid Maximum Amplitude (AA MA) Fanah Hagos* Fanah Hagos Dua Anahita Patel Shiv Morrow Katherine Suarez Ferreira Sasha Patricia Lee Ivy
Background: Peripheral artery disease (PAD), resulting from atherosclerotic arterial occlusion, affects over 200 million individuals worldwide. Revascularization procedures, such as extremity artery bypass or endovascular stenting, are common to enhance limb blood perfusion. Thromboelastography with platelet mapping (TEG-PM) provides a comprehensive assessment of coagulation dynamics and holds potential for patient-centered thromboprophylaxis. Aim: (1) Evaluate the utility of ADP MA and AA MA, in conjunction with platelet aggregation/ inhibition. (2) Assess the impact of common comorbidities on TEG-PM values. Methods: Linear models used to examine time and comorbidity differences in ADP MA and AA MA, and Chi-squared tests to evaluate relationships between disease status and postoperative adverse events. Cox proportional hazards models assessed ADP MA and AA MA relationships with occlusion/stenosis in the intervention area, with cut point analysis for corresponding Kaplan-Meier curves. Results: A cohort of 194 patients, with a mean age of 72.0 years and a BMI of 26.6, the majority had hypertension (91%) and hyperlipidemia (91%), while 52.6% had diabetes. Diabetic patients exhibited significantly higher ADP and AA at both time points (p≤0.0228), contrasting with those with hyperlipidemia (p≥0.144). Cox proportional hazard analysis revealed a 2% increase in the risk of occlusion/stenosis with a 1 mm rise in AA MA (HR=1.02, 95%CI=1.00-1.04, p=0.031). Although ADP MA did not reach significance (HR=1.014, 95% CI=0.993-1.035, p=0.208), AA MA emerged as a significant predictor (HR=1.019, 95% CI=1.002-1.036, p=0.031). The optimal cut point for AA MA was identified as 49.4, yielding an AUC of 0.6186 in the univariable model. Furthermore, ADP MA had an optimal cut point of 49.3 with an AUC of 0.545 in the univariable model. Conclusion: findings underscore the potential of ADP MA/ AA MA as a meaningful indicator for predicting occlusion/stenosis events after revascularization.
