The Use of Thrombin Generation as a Predictor of Thrombosis in Peripheral Artery Disease.

BACKGROUND

Thrombosis of stents or bypass grafts is the major cause of amputation in peripheral artery disease (PAD) patients postrevascularization. Calibrated automated thrombography (CAT) is a global coagulation assay that measures thrombin generation (TG) and has been used to evaluate bleeding risk. However, its utility in PAD has not been investigated. This study aims to evaluate if CAT can predict thrombotic events in PAD patients.

METHODS

Seventy-nine PAD patients who underwent revascularization at our single tertiary care institute were prospectively enrolled and followed from 2022 to 2024. Patients were stratified based on the thrombotic events during follow-up. CAT parameters including lag time, peak TG, rate of TG, and endogenous thrombin potential were measured at 1 week, 1,2,3,6, and 9 months and compared between the groups. Groups were statistically compared using Mann-Whitney U tests. Receiver operating characteristic curves were generated.

RESULTS

In our cohort of 79 patients, thrombotic events occurred in 20 patients (25.3%). Patients who developed thrombosis demonstrated significantly higher peak TG (246.2 vs. 169.2, P = 0.045) and TG rate (87.62 vs. 50.76, P = 0.005) when compared to the nonthrombotic group. Receiver operating characteristic analysis revealed that peak TG showed a modest predictive value (area under the curve = 0.650, 95% confidence interval: 0.518-0.782, P = 0.046) with an optimal cutoff value of >172 nM (sensitivity 80.0%, specificity 50.8%). The rate of TG demonstrated better discriminatory ability (area under the curve = 0.708, 95% confidence interval: 0.578-0.837, P = 0.006) with an optimal cutoff value > 57.44 nM/min (sensitivity 80.0%, specificity 57.6%).

CONCLUSION

Peak TG and TG rate may serve as potential indicators for thrombosis in PAD patients.