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Related Experiment Video

Updated: Sep 8, 2025

Microfluidics in Assessing Platelet Function
06:47

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Published on: November 8, 2024

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Predicting bleeding risk in PAD patients on antiplatelets using TEG coagulation testing.

Adriana A Rodriguez Alvarez1, Isabella Ferlini Cieri1, Mounika Boya1

  • 1Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114 USA.

Journal of Surgery and Research
|August 20, 2025
PubMed
Summary

High platelet inhibition and low maximum amplitude of adenosine diphosphate (MA ADP) measured by Thromboelastography with Platelet Mapping (TEG-PM) can predict bleeding risk in peripheral artery disease (PAD) patients on antithrombotic therapy.

Keywords:
Antiplatelet therapyBleeding riskHemorrhagePeripheral arterial diseasePlatelet function testingRevascularizationThromboelastography

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Area of Science:

  • Cardiovascular Medicine
  • Hematology
  • Surgical Research

Background:

  • Bleeding is a significant complication of antithrombotic therapy.
  • The predictive value of Thromboelastography with Platelet Mapping (TEG-PM) for bleeding risk in peripheral artery disease (PAD) is not well-established.
  • Current antithrombotic management in PAD may benefit from improved risk stratification tools.

Purpose of the Study:

  • To evaluate the utility of TEG-PM parameters, specifically platelet inhibition (PI) and MA ADP, in predicting bleeding risk in PAD patients undergoing lower extremity revascularization.
  • To determine optimal cutoff values for PI and MA ADP for identifying patients at increased risk of bleeding.

Main Methods:

  • Prospective evaluation of 234 PAD patients undergoing lower extremity revascularization over a one-year follow-up period.
  • Bleeding events were defined as clinically significant hemorrhages requiring intervention or transfusion.
  • Platelet function was assessed using TEG-PM, with Mann-Whitney U and ROC analyses used to compare groups and identify predictive thresholds.

Main Results:

  • 14% of patients experienced a bleeding event.
  • Patients with bleeding events showed significantly higher PI (94.5% vs. 24.1%) and lower MA ADP (22.4 vs. 52).
  • ROC analysis identified PI >86.4% (AUC: 0.89) and MA ADP <31.9 (AUC: 0.85) as significant predictors of bleeding risk.

Conclusions:

  • Elevated platelet inhibition and reduced MA ADP levels are associated with increased bleeding risk in PAD patients.
  • TEG-PM parameters may serve as valuable biomarkers for personalized antithrombotic management in PAD.
  • These findings suggest TEG-PM can aid in stratifying bleeding risk and optimizing antiplatelet therapy in PAD.