Skip to main content
2025 Vascular Annual Meeting Main banner
Icon Legend
This session is not in your schedule.
This session is in your schedule. Click again to remove it.
Presentation Icons
Ticketed Event
Ticketed Event

P6: Plenary Session 6

SS15 - Personalized Thromboprophylaxis Guided by the TARGET Protocol Reduces Thrombosis and Improves Thrombotic Rates and Survival in Peripheral Artery Disease Patients Post Revascularization

Friday, June 6, 2025
10:08 AM – 10:19 AM CT
Location: Morial CC, First Floor, Great Hall A
Objectives: Thromboprophylaxis medications are used to prevent arterial thrombosis (AT) in patients with peripheral artery disease (PAD) post-revascularization. Current practices use a “one size fits all approach” to thromboprophylaxis with dual antiplatelet therapy or rivaroxaban and aspirin which is insufficient, as up to 20% of patients experience arterial thrombosis/stenosis at the intervention site within 6 months. This interim analysis of a single armed interventional study aimed to evaluate the impact of personalized thromboprophylaxis therapy guided by viscoelastic testing to decrease rates of thrombosis/stenosis post endovascular intervention.

Methods: PAD patients (≥50 years) undergoing endovascular revascularization from 2020 to 2024 were enrolled. The control group was an observational cohort receiving standard-of-care thromboprophylaxis. The intervention group received personalized thromboprophylaxis medication adjustments based on the Thromboprophylaxis for Arterial Revascularization to Guide Elderly Therapy (TARGET) protocol which personalized thromboprophylaxis based on individualized coagulation profiles to achieve a platelet inhibition level of >30%. Patients were followed for 12 months to assess primary outcomes of thrombosis as well as secondary outcomes of bleeding and mortality. Bivariate comparisons and survival analyses were conducted to evaluate the impact of personalized thromboprophylaxis on clinical outcomes. Kaplan-Meier survival curves and Cox proportional hazards models were utilized to compare survival between groups.

Results: The study included 339 participants, with 277 in the control group and 62 in the intervention group. Both groups were comparable in terms of age, sex, race/ethnicity, BMI, tobacco use, and common comorbidities (Table I). Compared to the control group, the intervention group had lower rates of thrombosis (6.5% vs. 20.9%, P < 0.008) (Fig 1) but experienced more minor bleeding events (14.5% vs. 3.6%, P < 0.001). There was no difference in distal vessel runoff between groups. The intervention group had better survival outcomes (P < 0.035) and a reduced incidence of amputation, though this was not statistically significant. Multivariable analysis also showed that personalized thromboprophylaxis was associated with reduced thrombosis and improved survival (HR = 0.34, 95% CI 0.12–0.95, P = 0.039). Having a previous intervention on the index limb was a significant predictor of thrombosis, with HRs of 2.08 (P = 0.005) and 1.69 (P = 0.048), suggesting a higher risk for these individuals.

Conclusions: Personalized thromboprophylaxis guided by the TARGET protocol using viscoelastic testing reduced thrombosis rates and improved survival in PAD patients undergoing endovascular revascularization. This approach provides a potential strategy for improving clinical outcomes by optimizing antiplatelet therapy, particularly in high-risk patients.