Thromboelastography Use: Sex, a Possible Predictor of Thrombosis in Peripheral Artery Disease

Thrombosis of bypass grafts or stents postrevascularization procedures of lower extremities is a leading cause of amputation and higher morbidity in patients with peripheral artery disease (PAD). The aim of this study is to evaluate the relationship between sex and the risk of postrevascularization thrombosis in patients with PAD.

Patient undergoing procedures between January 2021 and July 2023 underwent preoperative thromboelastography-platelet mapping (TEG-PM) analysis and were prospectively observed up to POD#60 to evaluate intervention-related thrombosis. A multivariable logistic regression analysis was carried out to assess if sex is an independent predictor of the above outcome and what specific coagulation parameters differed between the two.

A total of 177 TEG-PM preoperative samples from patients were analyzed. Sixty-three (35.6%) were females. Of whom, only nine (14.2%) had >30% adenosine diphosphate-platelet inhibition, 15 (23.8%) received anticoagulation within 24 h of the intervention, and 6 (9.5%) had intervention-related thrombosis with no significant differences in baseline thrombosis risk factors. A total of 38 (21.5%) patients received anticoagulation within 24 h of the intervention. On multivariable logistic regression, females did not have a significant association with of having an intervention-related thrombotic event compared with males (odds ratio 0.19, 95% confidence interval 0.03-1.12; P = 0.067).

There is significant variation between the treatment patterns in patients postrevascularization. Sex may be associated with the risk of thrombosis, but this can be modulated by appropriate, individualized therapy guided by TEG-PM. A larger study population is needed to better identify the independent predictors of thrombotic events.