Rodriguez Alvarez Adriana A, Cieri Isabella Ferlini, Morrow Katherine L, Boya Mounika Naidu, Suarez Ferreira Sasha P, Patel Shiv S, Dua Anahita
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
J Vasc Surg. 2025 Jul;82(1):173-179. doi: 10.1016/j.jvs.2025.02.002. Epub 2025 Feb 7.
This study aimed to determine whether age affects thromboelastography (TEG) coagulation profiles among elderly patients with peripheral arterial disease. We hypothesized that TEG parameters would not significantly differ between age groups when controlled for anticoagulation regimen.
This was a prospective, single-institution, observational study that included patients aged 65 years and older who underwent open or endovascular lower extremity revascularization for peripheral arterial disease from December 2020 through December 2023. A total of 158 patients were grouped into categories: by age (65 to 74 years and 75+ years) and anticoagulation regimen (single antiplatelet [50%], dual antiplatelet [15%], therapeutic anticoagulation [27%], none [8%]). Objective TEG coagulation profiles were collected preoperatively and were compared among patient groups. One-way analysis of variance was used to compare three or more groups of continuous data, and χ analysis or Fisher exact test were used to compare categorical data.
Among 158 patients (36.4% female; median age, 74.5 ± 6.6 years), there were no significant differences in TEG parameters (reaction time, maximum amplitude, lysis at 30 minutes, angle, adenosine diphosphate % aggregation, adenosine diphosphate % inhibition) between age groups when stratified by anticoagulation regimen (all P > .05). Thrombosis rates were similar between age groups (21.1% vs 20.6%; P = .936), but mortality was significantly higher in the 75+ group (20.6% vs 5.6%; P = .005).
Objective coagulation parameters do not appear to vary significantly among age groups within the elderly population when controlled for antiplatelet/anticoagulant regimen. TEG profiles may be used to guide anticoagulation management among elderly patients. Further studies can help elucidate the full utility of TEG profiles for coagulation surveillance among elderly patients.
本研究旨在确定年龄是否会影响老年外周动脉疾病患者的血栓弹力图（TEG）凝血指标。我们假设在控制抗凝方案的情况下，不同年龄组的TEG参数不会有显著差异。
这是一项前瞻性、单机构观察性研究，纳入了2020年12月至2023年12月期间因外周动脉疾病接受开放或血管腔内下肢血运重建术的65岁及以上患者。共有158例患者按年龄（65至74岁和75岁及以上）和抗凝方案（单一抗血小板治疗[50%]、双重抗血小板治疗[15%]、治疗性抗凝[27%]、无抗凝[8%]）进行分组。术前收集客观的TEG凝血指标，并在患者组间进行比较。采用单因素方差分析比较三组或更多组的连续数据，采用χ²分析或Fisher精确检验比较分类数据。
在158例患者中（女性占36.4%；中位年龄为74.5±6.6岁），按抗凝方案分层时，不同年龄组之间的TEG参数（反应时间、最大振幅、30分钟时的纤溶、角度、二磷酸腺苷%聚集率、二磷酸腺苷%抑制率）无显著差异（所有P>.05）。不同年龄组的血栓形成率相似（21.1%对20.6%；P=.936），但75岁及以上组的死亡率显著更高（20.6%对5.6%；P=.005）。
在控制抗血小板/抗凝方案的情况下，老年人群中不同年龄组的客观凝血参数似乎没有显著差异。TEG指标可用于指导老年患者的抗凝管理。进一步的研究有助于阐明TEG指标在老年患者凝血监测中的全部效用。
