Alvarez Adriana A Rodriguez, Cieri Isabella Ferlini, Boya Mounika, Patel Shiv, Dua Anahita
Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA 02114 USA.
J Surg Res (Houst). 2025;8(3):335-341. doi: 10.26502/jsr.10020456. Epub 2025 Jul 22.
Bleeding is a major concern while using antithrombotic therapy. While Thromboelastography with Platelet Mapping (TEG-PM) predicts postoperative bleeding and platelet dysfunction in trauma, its utility in peripheral artery disease (PAD) remains unclear. Hence, this study aimed to evaluate whether platelet inhibition (PI) and maximum amplitude of adenosine diphosphate (MA ADP) can predict bleeding risk in PAD.
Patients with PAD undergoing lower extremity revascularization between 2021-2025 were prospectively evaluated and monitored for one year to identify bleeding events. Bleeding events were defined as clinically significant hemorrhages that required medical intervention or transfusion. Patients were stratified based on the occurrence of bleeding, and descriptive statistics characterized each group. The Mann-Whitney U test assessed differences in platelet function, while receiver operating characteristic (ROC) analysis determined the optimal TEG-PM cutoff values for predicting increased bleeding risk.
A total of 234 patients were analyzed, of whom 14 (5%) experienced a bleeding event. The bleeding cohort exhibited higher platelet inhibition (94.5% vs. 24.1%; p<0.0001) and lower MA ADP (22.4 vs. 52; p<0.0001), suggesting reduced platelet aggregation and clot strength. ROC analysis revealed platelet inhibition >86.4% (AUC: 0.89, sensitivity: 71%, specificity: 92%) and MA ADP <31.9 (AUC: 0.85, sensitivity: 79%, specificity: 85%) as predictive thresholds for bleeding risk.
High platelet inhibition (>86.4%) and low MA ADP (<31.9%) may serve as indicators of bleeding risk in PAD patients on antiplatelets, highlighting the potential utility of TEG-PM in guiding personalized antithrombotic management.
在使用抗栓治疗时，出血是一个主要问题。虽然血小板功能检测的血栓弹力图（TEG-PM）可预测创伤患者术后出血和血小板功能障碍，但其在周围动脉疾病（PAD）中的应用尚不清楚。因此，本研究旨在评估血小板抑制（PI）和二磷酸腺苷最大振幅（MA ADP）是否可预测PAD患者的出血风险。
前瞻性评估2021年至2025年间接受下肢血管重建术的PAD患者，并对其进行为期一年的监测，以确定出血事件。出血事件定义为需要医疗干预或输血的具有临床意义的出血。根据出血情况对患者进行分层，并用描述性统计对每组进行特征分析。采用曼-惠特尼U检验评估血小板功能差异，同时通过受试者操作特征（ROC）分析确定预测出血风险增加的最佳TEG-PM临界值。
共分析了234例患者，其中14例（5%）发生了出血事件。出血组的血小板抑制率更高（94.5%对24.1%；p<0.0001），MA ADP更低（22.4对52；p<0.0001），提示血小板聚集和凝血强度降低。ROC分析显示，血小板抑制>86.4%（AUC：0.89，敏感性：71%，特异性：92%）和MA ADP<31.9（AUC：0.85，敏感性：79%，特异性：85%）是出血风险的预测阈值。
高血小板抑制（>86.4%）和低MA ADP（<31.9%）可能是接受抗血小板治疗的PAD患者出血风险的指标，突出了TEG-PM在指导个性化抗栓管理中的潜在应用价值。
