Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data.
Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data.
复制标题
DOI：
10.1161/jaha.122.027790
复制
发表时间：
2023-01-03
影响因子：
5.4
通讯作者：
Dua, Anahita
中科院分区：
文献类型：
--
作者：
Majumdar, Monica;Hall, Ryan P.;Feldman, Zachary;Goudot, Guillaume;Sumetsky, Natalie;Jessula, Samuel;Kirshkaln, Amanda;Bellomo, Tiffany;Chang, David;Cardenas, Jessica;Patell, Rushad;Eagleton, Matthew;Dua, Anahita
关键词：
外周动脉疾病在我们全球老龄化人口中是地方病，全世界有2亿英镑受到影响。血管重建术后移植物/支架血栓形成是常见的，经常导致截肢、主要不良心血管事件和心血管死亡。优化药物以减少血栓形成是最重要的；然而，关于如何在这一异质人群中使用和监测抗血栓治疗的指导意见有限。血栓弹性成像与血小板成像(TEG-PM)提供了全面的凝血指标，可能是下一阶段以患者为中心的血栓预防不可或缺的一部分。这项前瞻性研究旨在确定TEG-PM是否可以预测下肢血管重建术后的亚急性移植物/支架血栓形成，以及是否可以建立客观的切点值来识别这些高危患者。我们对接受下肢血管重建术的患者进行了一项单中心前瞻性观察研究。术后1 随访观察复合终点移植物/支架血栓形成情况。事件组中血栓形成前时间点的TAG-PM分析与非事件组中最后一次术后随访进行比较。COX比例风险分析研究了TEG-PM指标与血栓形成的关系。切点分析探讨了TEG-PM指标对高危人群的预测能力。总共分析了162例患者，其中30例(18.5%)发生了移植物/支架血栓形成。血栓形成组血小板聚集率(79.7±15.7)%显著高于对照组(58.5±26.4)%，血小板抑制率(20.7±15.6)%显著低于对照组(41.1±26.6)%(P均<0.01)。COX比例风险分析显示，血小板聚集每增加1%，在研究期间发生事件的风险增加5%(风险比，1.05[95%CI，1.02-1.07]；P<；0.01)。以>；70.8%的血小板聚集率和/或29.2%的血小板抑制率作为判断血栓形成高危人群的最佳切点，敏感性为87%，特异性为70%至71%。在接受下肢血管重建术的患者中，血小板反应性升高是亚急性移植/支架术后血栓形成的预测因素。根据70.8%的血小板聚集率和29.2%的血小板抑制率的分界点，为高危患者考虑一种替代或强化的抗血栓治疗方案可能会降低术后血栓事件的风险。
Peripheral artery disease is endemic in our globally aging population, with >200 million affected worldwide. Graft/stent thrombosis after revascularization is common and frequently results in amputation, major adverse cardiovascular events, and cardiovascular mortality. Optimizing medications to decrease thrombosis is of paramount importance; however, limited guidance exists on how to use and monitor antithrombotic therapy in this heterogeneous population. Thromboelastography with platelet mapping (TEG‐PM) provides comprehensive coagulation metrics and may be integral to the next stage of patient‐centered thrombophrophylaxis. This prospective study aimed to determine if TEG‐PM could predict subacute graft/stent thrombosis following lower extremity revascularization, and if objective cut point values could be established to identify those high‐risk patients. We conducted a single‐center prospective observational study of patients undergoing lower extremity revascularization. Patients were followed up for the composite end point postoperative graft/stent thrombosis at 1 year. TEG‐PM analysis of the time point before thrombosis in the event group was compared with the last postoperative visit in the nonevent group. Cox proportional hazards analysis examined the association of TEG‐PM metrics to thrombosis. Cut point analysis explored the predictive capacity of TEG‐PM metrics for those at high risk. A total of 162 patients were analyzed, of whom 30 (18.5%) experienced graft/stent thrombosis. Patients with thrombosis had significantly greater platelet aggregation (79.7±15.7 versus 58.5±26.4) and lower platelet inhibition (20.7±15.6% versus 41.1±26.6%) (all P<0.01). Cox proportional hazards analysis revealed that for every 1% increase in platelet aggregation, the hazard of experiencing an event during the study period increased by 5% (hazard ratio, 1.05 [95% CI, 1.02–1.07]; P<0.01). An optimal cut point of >70.8% platelet aggregation and/or <29.2% platelet inhibition identifies those at high risk of thrombosis with 87% sensitivity and 70% to 71% specificity. Among patients undergoing lower extremity revascularization, increased platelet reactivity was predictive of subacute postoperative graft/stent thrombosis. On the basis of the cut points of >70.8% platelet aggregation and <29.2% platelet inhibition, consideration of an alternative or augmented antithrombotic regimen for high‐risk patients may decrease the risk of postoperative thrombotic events.