TEG-Guided Anticoagulation Assessment in Deep Vein Arterialization: A Prospective Analysis.

BACKGROUND

Deep vein arterialization (DVA) is an innovative surgical technique aimed at enhancing blood flow in compromised limbs facing amputation. Maintenance of flow postrevascularization is crucial to limb salvage. As this is a new technique, no standardized thromboprophylaxis regime is currently established, and postprocedure thromboprophylaxis is at the discretion of the proceduralist. This study aims to evaluate coagulation profiles using viscoelastic studies in peripheral artery disease patients who underwent DVA, assessing the impact of various postprocedure thromboprophylaxis regimens.

METHODS

Patients (aged > 60 years) undergoing DVA were prospectively evaluated using thromboelastography at baseline, 1, 3, and 6 months (2020-2024). Postprocedure thromboprophylaxis included mono antiplatelet therapy (MAPT), MAPT + direct oral anticoagulant (DOAC), dual antiplatelet therapy (DAPT), or DAPT + DOAC. Coagulation profiles were analyzed using descriptive statistics.

RESULTS

Among 16 patients (mean age 66.6 years, 75% male/Caucasian), hypertension and hyperlipidemia were present in 91%, and diabetes in 88%. The DAPT + DOAC group showed consistently superior platelet inhibition with the lowest adenosine diphosphate maximum amplitude values throughout baseline (35.65 mm vs. 42.2-65.03 mm in other groups), 1 month (26.7 mm vs. 32.14-69.4 mm), 3 months (27.36 mm vs. 32.2-39.97 mm), and 6 months (43.7 mm vs. 50.2-50.5 mm). MAPT demonstrated the slowest clot strengthening (citrated kaolin angle 65.25° vs. 68.7-71.55°).

CONCLUSION

Thromboelastography with platelet mapping demonstrated enhanced platelet inhibition and reduced clot formation in the DAPT + DOAC group, suggesting the importance of coagulation monitoring.