Cieri Isabella F, Rodriguez Alvarez Adriana A, Patel Shiv, Boya Mounika, Nurko Andrea, Teeple William, Dua Anahita
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Ann Vasc Surg. 2025 Mar;112:287-297. doi: 10.1016/j.avsg.2024.12.054. Epub 2024 Dec 27.
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.
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.
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°).
Thromboelastography with platelet mapping demonstrated enhanced platelet inhibition and reduced clot formation in the DAPT + DOAC group, suggesting the importance of coagulation monitoring.
深静脉动脉化（DVA）是一种创新的外科技术，旨在增加面临截肢风险的受损肢体的血流。血管重建术后维持血流对挽救肢体至关重要。由于这是一项新技术，目前尚未建立标准化的血栓预防方案，术后血栓预防由手术医生自行决定。本研究旨在通过粘弹性研究评估接受DVA的外周动脉疾病患者的凝血情况，评估各种术后血栓预防方案的影响。
对接受DVA的患者（年龄>60岁）在基线、1个月、3个月和6个月（2020 - 2024年）进行前瞻性血栓弹力图评估。术后血栓预防包括单药抗血小板治疗（MAPT）、MAPT + 直接口服抗凝剂（DOAC）、双联抗血小板治疗（DAPT）或DAPT + DOAC。使用描述性统计分析凝血情况。
16例患者（平均年龄66.6岁，75%为男性/白种人）中，91%患有高血压和高脂血症，88%患有糖尿病。DAPT + DOAC组在整个基线期（35.65毫米，其他组为42.2 - 65.03毫米）、1个月（26.7毫米，其他组为32.14 - 69.4毫米）、3个月（27.36毫米，其他组为32.2 - 39.97毫米）和6个月（43.7毫米，其他组为50.2 - 50.5毫米）均显示出持续更好的血小板抑制效果，腺苷二磷酸最大振幅值最低。MAPT显示凝血块强化最慢（枸橼酸化高岭土角为65.25°，其他组为68.7 - 71.55°）。
血小板功能分析的血栓弹力图显示DAPT + DOAC组血小板抑制增强且凝血块形成减少，提示凝血监测的重要性。
