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Updated: Aug 12, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Use of Thromboelastography with Platelet Mapping to Identify Prothrombotic Coagulation Profiles in Patients with
Ryan Hall1, Monica Majumdar1, Ryan Cassidy2
1From the Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA (Hall, Majumdar, Feldman, Suarez, Goudot, Bellomo, Jessula, Kirshkaln, Dua).
Insights
Patients with coronary and peripheral artery disease (CAD and PAD) show increased clotting risk. Thromboelastography-platelet mapping revealed prothrombotic profiles, potentially guiding prevention of major adverse limb events (MALEs).
Area of Science:
- Cardiovascular Medicine
- Hematology
- Vascular Surgery
Background:
- Patients with concomitant coronary artery disease (CAD) and peripheral artery disease (PAD) face high risks of major adverse limb events (MALEs).
- Thrombosis prevention is critical in this population.
- Identifying prothrombotic coagulation profiles can aid targeted thromboprophylaxis.
Purpose of the Study:
- To compare coagulation profiles in patients with both CAD and PAD versus those with PAD alone.
- To identify potential prothrombotic markers associated with MALEs in this high-risk group.
- To evaluate the utility of thromboelastography-platelet mapping (TEG-PM) in perioperative risk stratification.
Main Methods:
- A cohort of 114 patients undergoing lower extremity revascularization were analyzed.
- Thromboelastography-platelet mapping (TEG-PM) was performed preoperatively and serially for up to 6 months.
- Coagulation profiles were compared between patients with significant CAD and those with PAD alone, with MALE occurrence recorded.
Main Results:
- Patients with significant CAD (28.1%) exhibited higher rates of atrial fibrillation.
- The CAD group showed lower ADP-platelet inhibition and higher aggregation, along with greater clot strength.
- Postoperative MALEs occurred in 28.1% of the CAD group versus 22.9% of the PAD-alone group; decreased platelet inhibition correlated with MALEs.
Conclusions:
- Patients with CAD and PAD undergoing lower extremity revascularization present with prothrombotic TEG-PM profiles.
- These patients were less frequently on dual antiplatelet therapy but more on full anticoagulation.
- Viscoelastic assays like TEG-PM may be valuable for coagulation assessment in complex cardiovascular patients.
Background:
Patients with concomitant coronary and peripheral artery disease (CAD and PAD) are at significant risk for major adverse limb events (MALEs). Prevention of thrombosis in this population is of paramount importance. Identifying prothrombotic coagulation profiles in this cohort may facilitate targeted thromboprophylaxis. We compared coagulation profiles of those with CAD and PAD to those with PAD alone during the perioperative period of lower extremity revascularization.
Study Design:
Patients undergoing lower extremity revascularization underwent thromboelastography-platelet mapping (TEG-PM) analysis preoperatively and at serial intervals for up to 6 months. Coagulation profiles of patients with significant CAD (defined as history of coronary artery bypass graft or percutaneous coronary intervention) and PAD were compared with those with PAD alone. MALE in the postoperative period was recorded.
Results:
Four hundred seventy-seven TEG-PM samples from 114 patients were analyzed; 28.1% had a history of significant CAD. The incidence of atrial fibrillation was higher in this group. The significant CAD group had lower ADP-platelet inhibition, higher ADP-platelet aggregation, and greater maximum clot strength compared with patients with PAD alone. Patients with significant CAD were more frequently on full-dose anticoagulation, but less frequently on dual antiplatelet therapy; 28.1% of patients with significant CAD developed postoperative MALE compared with 22.9% of patients with PAD alone (p = 0.40). For both groups, patients who developed postoperative MALE demonstrated greater ADP-platelet aggregation and lower ADP-platelet inhibition.
Conclusions:
Patients with a history of significant CAD undergoing lower extremity revascularization demonstrated prothrombotic TEG-PM profiles, less frequent use of dual antiplatelet therapy, and greater rates of full-dose anticoagulation. Decreased platelet inhibition was also associated with postoperative MALE. This study underscores the potential utility of viscoelastic assays for coagulation profiling in complex cardiovascular patients.
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