Thromboelastography with Platelet Mapping Identifies High Platelet Reactivity is Associated with Obesity, Diabetes and Thrombotic Events.

OBJECTIVE: Identify prothrombotic coagulation profiles associated with diabetes and obesity using Thromboelastography SUMMARY BACKGROUND DATA: Metabolic comorbidities such as diabetes and obesity are considered pro-inflammatory states which theoretically increase the risk of perioperative thrombotic events across many surgical disciplines. Currently, there is a paucity of objective metrics to determine such risk and ideal pharmacologic targets. Thromboelastography with Platelet Mapping (TEG-PM) provides a comprehensive profile of coagulation and may provide insight into clot dysregulation.

METHODS: Patients undergoing lower extremity revascularization underwent serial TEG-PM analysis. The relationship between the TEG-PM metrics and thrombosis was evaluated. Pre-operative TEG-PM samples of patients with BMI≥25 were compared to those of patients with a normal BMI, and between patients with DM and those without.

RESULTS: 218 TEG-PM samples from 202 patients were analyzed. The BMI≥25 cohort showed significantly greater platelet aggregation [81.9%(±20.9)vs.68.6%(±27.7), p<.01]. Patients with DM were more frequently on full-dose anticoagulation [47.7%vs.29.7%p=.01] yet demonstrated increased clot strength, or ADP-Maximum Clot Amplitude(MA) [49.1(±16.1)vs.41.5(±17.1) and 37.7(±19.6)vs.31.6(±17.4)p<.01]. 49 patients experienced thrombosis and exhibited greater platelet aggregation [76.6%(±17.8)vs.66.8%(±30.4) p=.03] and greater ADP/AA MA [47.1(±16.6)vs.41.9(±18.8) and 38.2(±17.8)vs.32.5(±19.9) both p=.05]. Patients who thrombosed were more often diabetic [69.5% vs. 51.0% p=.03] and on full-dose anticoagulation [75.0%vs.56.8% p=.02].

CONCLUSION: Patients with a BMI≥ 25 and those with diabetes demonstrated TEG-PM profiles similar to patients with thrombosis. Diabetes was independently associated with thrombosis, and full-dose anticoagulation was not protective. This suggests the potential utility of TEG-PM for thrombotic risk stratification based on metabolic factors and suggests antiplatelet agents may be effective at prevention of thrombotic events in this population.