Utilization of Thromboelastography with Platelet Mapping to Predict Infection and Poor Wound Healing in Postoperative Vascular Patients

Majumdar, Monica; Lella, Srihari; Hall, Ryan; Sumetsky, Natalie; Waller, Harold D; McElroy, Imani; Sumpio, Brandon J.; Feldman, Zach M.; Kim, Young; DeCarlo, Charles; Warner, Mary Grace; Nuzzolo, Kathryn; Kirshkaln, Amanda; Dua, Anahita

doi:10.1016/j.avsg.2022.03.008

Cited by 4 publications

(2 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Thromboelastographic analysis with the adjunct of platelet mapping, on the other hand, is a point‐of‐care technology that is increasingly available in tertiary centers and the first to be linked to real‐world clinical outcomes in patients with PAD. 24 The important benefit of using TEG‐PM is the ability to concurrently assess the coagulation and platelet pathways, offering the potential to study the additive, confounding, or null effect that anticoagulation management has on platelet function, which is yet to be established. Our data leverages this comprehensive capacity by uncovering a series of impactful findings: Platelet mapping demonstrates that postoperative platelet reactivity is significantly higher in those with events, before the diagnosis of thrombosis, and despite comparable antiplatelet management between groups.…”

Section: Discussionmentioning

confidence: 99%

“… 21 , 23 Promising data for the prediction of clinical outcomes in cerebrovascular disease, for venous thromboembolic events, and even the prothrombotic state associated with surgical site infections and poor wound healing have preceded the use of thromboelastography in arterial thrombosis, despite the intricate relationship between peripheral vascular disease and coagulation. 23 , 24 …”

mentioning

confidence: 99%

See 1 more Smart Citation

Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data

Majumdar

Hall

Feldman

et al. 2023

JAHA

View full text Add to dashboard Cite

Background Peripheral artery disease is endemic in our globally aging population, with >200 million affected worldwide. Graft/stent thrombosis after revascularization is common and frequently results in amputation, major adverse cardiovascular events, and cardiovascular mortality. Optimizing medications to decrease thrombosis is of paramount importance; however, limited guidance exists on how to use and monitor antithrombotic therapy in this heterogeneous population. Thromboelastography with platelet mapping (TEG‐PM) provides comprehensive coagulation metrics and may be integral to the next stage of patient‐centered thrombophrophylaxis. This prospective study aimed to determine if TEG‐PM could predict subacute graft/stent thrombosis following lower extremity revascularization, and if objective cut point values could be established to identify those high‐risk patients. Methods and Results We conducted a single‐center prospective observational study of patients undergoing lower extremity revascularization. Patients were followed up for the composite end point postoperative graft/stent thrombosis at 1 year. TEG‐PM analysis of the time point before thrombosis in the event group was compared with the last postoperative visit in the nonevent group. Cox proportional hazards analysis examined the association of TEG‐PM metrics to thrombosis. Cut point analysis explored the predictive capacity of TEG‐PM metrics for those at high risk. A total of 162 patients were analyzed, of whom 30 (18.5%) experienced graft/stent thrombosis. Patients with thrombosis had significantly greater platelet aggregation (79.7±15.7 versus 58.5±26.4) and lower platelet inhibition (20.7±15.6% versus 41.1±26.6%) (all P <0.01). Cox proportional hazards analysis revealed that for every 1% increase in platelet aggregation, the hazard of experiencing an event during the study period increased by 5% (hazard ratio, 1.05 [95% CI, 1.02–1.07]; P <0.01). An optimal cut point of >70.8% platelet aggregation and/or <29.2% platelet inhibition identifies those at high risk of thrombosis with 87% sensitivity and 70% to 71% specificity. Conclusions Among patients undergoing lower extremity revascularization, increased platelet reactivity was predictive of subacute postoperative graft/stent thrombosis. On the basis of the cut points of >70.8% platelet aggregation and <29.2% platelet inhibition, consideration of an alternative or augmented antithrombotic regimen for high‐risk patients may decrease the risk of postoperative thrombotic events.

show abstract

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data

Majumdar

Hall

Feldman

et al. 2023

JAHA

View full text Add to dashboard Cite

show abstract

Optimizing platelet inhibition in peripheral artery disease: A comparison of mono-antiplatelet therapy and dual-antiplatelet therapy using thromboelastography

Lee,

Suarez,

Hall

et al. 2024

Vascular

View full text Add to dashboard Cite

Background Antiplatelet therapy is used to prevent thrombosis in patients with peripheral artery disease (PAD) following revascularization. However, the current standard of care for these patients remains at the physician’s discretion, varying from mono-antiplatelet therapy (MAPT) to dual-antiplatelet therapy (DAPT). Viscoelastic assays such as Thromboelastography with Platelet Mapping (TEG-PM) provide insight into individual coagulation profiles and measure real-time platelet function. This prospective, observational study looks at the differences in platelet function for patients on MAPT versus DAPT using TEG-PM. Methods Patients with PAD undergoing revascularization were prospectively evaluated between December 2020 and June 2023. TEG-PM analysis compared platelet function for patients prescribed MAPT (aspirin or clopidogrel) at the initial encounter and DAPT (aspirin and clopidogrel) at the next visit. Platelet function measured in percent inhibition was evaluated at these visits, and within-group t-tests were performed. Results Of the 195 patients enrolled, 486 samples were analyzed by TEG-PM. Sixty-four patients met the study criteria. At the initial visit, 52 patients had been prescribed aspirin, and 12 patients had been prescribed clopidogrel. For patients initially prescribed aspirin MAPT, an increase of 96.8%in the mean ADP platelet inhibition was exhibited when transitioning to DAPT [22.0% vs. 43.3%, p < .01], as well as an increase of 34.6%in the mean AA platelet inhibition when transitioning to DAPT [60.9% vs. 82.0%, p < .01]. For patients prescribed initial clopidogrel MAPT, an increase of 100% in AA platelet inhibition was exhibited on DAPT compared to the MAPT state [42.3% vs. 84.6%, p < .01]. Conclusions Patients on DAPT showed a significant increase in platelet inhibition when compared to initial aspirin MAPT. A significant difference in AA %platelet inhibition was shown for patients on DAPT when compared to initial clopidogrel MAPT. The results show that patients may benefit from DAPT post-revascularization. Personalizing antiplatelet therapy with objective viscoelastic testing to confirm adequate treatment may be the next step in optimizing patient outcomes to reduce thrombosis in PAD patients.

show abstract

Wound Management, Healing, and Early Prosthetic Rehabilitation: Part 1 - A Scoping Review of Healing and Non-Healing Definitions

Williams-Reid,

Johannesson,

Buis

2024

Can. Prosthet. Orthot. J.

View full text Add to dashboard Cite

BACKGROUND: Following lower limb amputation, timely prosthetic fitting enhances mobility and quality of life. However, inconsistent definitions of surgical site healing complicate prosthesis readiness assessment and highlight the need for objective wound management measures. OBJECTIVE: This review aimed to compile definitions of healing and non-healing provided in the literature investigating biomarkers of healing of the tissues and structures found in the residual limbs of adults with amputation. METHODOLOGY: A scoping review was conducted following JBI and PRISMA-ScR guidance. Searches using “biomarkers,” “wound healing,” and “amputation” were performed on May 6, 2023, on Web of Science, Ovid MEDLINE, Ovid Embase, Scopus, Cochrane, PubMed, and CINAHL databases. Inclusion criteria were: 1) References to biomarkers and healing; 2) Residuum tissue healing; 3) Clear methodology with ethical approval; 4) Published from 2017 onwards. Articles were assessed for quality (QualSyst tool) and evidence level (JBI system). FINDINGS: Of 3,306 articles screened, 219 met the inclusion criteria and are reviewed in this article, with 77% rated strong quality. 43% of all included sources did not define healing, while the remainder used specific criteria including epithelialization (14%), wound size reduction (28%), gradings scales (3%), scarring (1%), absence of wound complications (2%), hydroxyproline levels (0.5%), no amputation (0.5%), or neovascularization (0.5%). 84% of included sources did not provide definitions of non-healing. Studies defining non-healing used criteria like wound complications (4%), the need for operative interventions (4%), or lack of wound size reduction (1%). For 10% of included sources, healing and non-healing definitions were considered not applicable given the research content. Total percentages exceed 100% for both healing and non-healing definitions because some sources used two definition classifications, such as epithelialization and wound size reduction. The findings indicate a lack of standardized definitions irrespective of study type. CONCLUSION: This review reveals significant gaps in current definitions of healing and non-healing, often based on superficial assessments that overlook deeper tissue healing and mechanical properties essential for prosthesis use. It emphasizes the need for comprehensive definitions incorporating biomarkers and psychosocial factors to improve wound management and post-amputation recovery. Layman's Abstract After a lower limb amputation, early prosthetic fitting can significantly improve quality of life. However, different definitions of surgical site healing make deciding when a prosthetic can be used difficult. This scoping review collected and compared definitions of healing and non-healing found in research about biological markers (biomarkers) that are used for tracking residual limb healing. On May 6, 2023, searches were conducted using terms like “biomarkers,” “wound healing,” and “amputation” across several databases. Studies were included if they discussed biomarkers, focused on residual limb healing, had clear methods and ethical approval, and were published during or after 2017. Of 3,306 articles screened, 219 met the criteria, with 77% rated as high quality. 43% of the included sources did not define healing. Definitions provided included new skin growth (14%), reduction in wound size (28%), grading scales (3%), scarring (1%), no complications (2%), hydroxyproline levels (0.5%), no need for amputation (0.5%), or new blood vessel formation (0.5%). 84% of sources did not define non-healing, with the remainder based on healing complications (4%), the need for more surgery (4%), or no reduction in wound size (1%). In 10% of included sources healing and non-healing definitions were considered not relevant to their research. Total percentages for healing and non-healing definitions exceeds 100% because some sources used two definitions, for example, new skin growth and reduction in wound size. Overall, the review shows gaps in definitions, many of which are too basic and ignore deeper tissue healing and factors needed for prosthetic use. More thorough definitions that include the physical, mental, and social sides of healing are needed to improve recovery. Article PDF Link: https://jps.library.utoronto.ca/index.php/cpoj/article/view/43715/33312 How To Cite: Williams-Reid H, Johannesson A, Buis A. Wound management, healing, and early prosthetic rehabilitation: Part 1 - A scoping review of healing and non-healing definitions. Canadian Prosthetics & Orthotics Journal. 2024; Volume 7, Issue 2, No.1. https://doi.org/10.33137/cpoj.v7i2.43715 Corresponding Author: Professor Arjan Buis, PhDDepartment of Biomedical Engineering, Faculty of Engineering, University of Strathclyde, Glasgow, Scotland.E-Mail: arjan.buis@strath.ac.ukORCID ID: https://orcid.org/0000-0003-3947-293X

show abstract

Utilization of Thromboelastography with Platelet Mapping to Predict Infection and Poor Wound Healing in Postoperative Vascular Patients

Cited by 4 publications

References 18 publications

Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data

Predicting Arterial Thrombotic Events Following Peripheral Revascularization Using Objective Viscoelastic Data

Optimizing platelet inhibition in peripheral artery disease: A comparison of mono-antiplatelet therapy and dual-antiplatelet therapy using thromboelastography

Wound Management, Healing, and Early Prosthetic Rehabilitation: Part 1 - A Scoping Review of Healing and Non-Healing Definitions

Contact Info

Product

Resources

About