(IP149) TEG-Guided Anticoagulation Assessment in Deep Vein Arterialization: A Prospective Analysis

Objectives: Deep Vein Arterialization (DVA) is an innovative surgical technique aimed at enhancing blood flow in compromised limbs facing amputation. Maintenance of flow post-revascularization is crucial to limb salvage. As this is a new technique, no standardized thromboprophylaxis regime is currently established, and post-procedure thromboprophylaxis is at the discretion of the proceduralist.
The aim of this study is to evaluate coagulation profiles using viscoelastic studies in peripheral artery disease (PAD) patients who underwent DVA, assessing the impact of various post-procedure thromboprophylaxis regimens.

Methods: Patients aged >60 years, diagnosed with PAD, and underwent DVA were prospectively evaluated using thromboelastography (TEG) from 2020-2024 at baseline and 1, 3, and 6 months post-procedure. Post-procedure thromboprophylaxis was categorized as monotherapy with antiplatelet therapy (MAPT), MAPT + direct oral anticoagulant (DOAC), dual antiplatelet therapy (DAPT), and DAPT + DOAC. Descriptive statistics were used to characterize the patient population and coagulation profiles including adenosine diphosphate maximum amplitude (ADP MA), inhibition rate, and clot-kinetics (CK) angles.

Results: Sixteen patients were analyzed, with a mean age of 66.6 years; 75% were male and Caucasian. Hypertension and hyperlipidemia were present in 91% of patients, and 88% had diabetes. The DAPT + DOAC group demonstrated superior platelet inhibition as evidenced by lower ADP MA values across all time points. At baseline, the DAPT + DOAC group showed the lowest ADP MA (35.65 mm) compared to other regimens (MAPT: 42.2 mm, MAPT + DOAC: 65.03 mm, DAPT: 48.75 mm). This trend continued at one month, where DAPT + DOAC maintained the lowest values (26.7 mm) compared to MAPT + DOAC (69.4 mm) and DAPT (32.14 mm). The three-month follow-up persistent superior platelet inhibition in the DAPT + DOAC group (27.36 mm) compared to other regimens (MAPT: 33.25 mm, MAPT + DOAC: 32.2 mm, DAPT: 39.97 mm). By six months, all groups showed increased ADP MA values, the DAPT + DOAC group maintained relatively low (43.7 mm) compared to MAPT + DOAC (50.5 mm) and DAPT (50.2 mm) (Fig. 1) (Table I). MAPT showed the slowest clot strengthening speed, with CK angles (degrees) of 65.25 (vs MAPT + DOAC:70.47, DAPT: 68.7, and DAPT + DOAC: 71.55), suggesting delayed fibrin cross-linking and weaker clot development.

Conclusions: Decreased ADP MA and increased ADP inhibition improved platelet inhibition and reduced clot formation, particularly in the DAPT + DOAC group. This highlights the need to monitor coagulation profiles closely to reduce thrombotic complications.