(PC042) Impact of Thromboelastographic-Platelet Mapping Parameters on Wound Healing in Peripheral Artery Disease Patients Undergoing Revascularization: Insights into Coagulation and Healing Dynamics

Objectives: Peripheral artery disease (PAD) involves narrowed arteries that limit blood flow to the extremities, impairing wound healing and presenting a clinical challenge. Thromboelastographic-Platelet Mapping (TEG-PM) assesses clot formation and dissolution, offering insights into hemostatic function. Key TEG parameters, Activated Clotting Time with Heparinase (Act-F) and Reaction Time (R time), are crucial for evaluating coagulation in PAD patients. Act-F neutralizes heparin to reveal intrinsic coagulation capabilities, while R time reflects clot formation initiation. This study aims to explore the relationship between these TEG parameters and wound healing in PAD patients, with the goal of guiding therapeutic strategies and enhancing healing rates.

Methods: From December 2020 to June 2024, PAD patients undergoing revascularization were prospectively evaluated. Patients with pre-operative wounds classified as Rutherford Category 5 were selected. TEG-PM was performed at baseline, post-operative day 1 (POD1), 1 month, 3 months, and 6 months. Key parameters assessed included clot formation (R-time), clot strengthening (K-time and α-angle), maximal clot amplitude (MA), and percent lysis at 30 minutes (% Lysis). Time-to-event survival analysis was used to analyze the average time to wound healing.

Results: Of the 229 enrolled individuals, 48 had pre-operative wounds (21%). Ten individuals either died before their wounds healed (n=5) or had wounds that remained unhealed by the study's end (n=5). After data cleaning, 38 individuals were included for general analyses and 48 for time-to-event analyses. At the 6-month follow-up, R-time showed a trend towards significance (p=0.0523). Specifically, patients with prolonged R-time, indicating longer clot formation, tended to have shorter wound healing times, with an explained variance of 18% (R²=0.18). Conversely, higher initial clot strength from fibrin contribution at POD1 (Act-F) was significantly associated with longer wound healing times (p=0.045), explaining 16% of the variance (R²=0.16). These findings suggest that while delayed clot formation may initially correlate with faster wound healing, increased fibrin strength early post-operatively is associated with prolonged healing.

Conclusions: The results suggest that a prolonged R-time at 6 months, indicative of delayed clot formation, is associated with shorter wound healing times. This trend, approaching statistical significance (p=0.0523), may reflect improved vascular patency over time, which enhances nutrient delivery and accelerates wound healing. In contrast, higher initial clot strength post intervention from fibrin at POD1 (Act-F) was linked to significantly longer wound healing times (p=0.045). This underscores the intricate relationship between coagulation factors and wound healing in PAD patients, highlighting the potential for TEG parameters to inform therapeutic strategies and enhance clinical outcomes.