# Thromboelastography and clinical outcomes in peripheral arterial disease: a systematic review and narrative synthesis

## TL;DR

This study reviews how thromboelastography (TEG) can help predict blood clotting outcomes and guide treatment in patients with peripheral arterial disease.

## Contribution

The study is the first to systematically evaluate TEG's role in predicting thrombotic events and guiding antiplatelet therapy in peripheral arterial disease.

## Key findings

- TEG-PM can quantify the response to antiplatelet therapy and guide individualized thromboprophylaxis.
- Parameters like maximum amplitude and platelet inhibition can predict thrombotic events in PAD patients.
- Substantial variability in treatment and patient factors was observed across the studies.

## Abstract

Thromboelastography (TEG) is a point-of-care test that provides a quantitative of measure of the dynamic changes in clot strength and viscoelastic properties of a whole blood sample. Although conventional coagulation tests are well established in vascular surgery, they do not identify the hypercoagulable state and response to antiplatelet therapy. The role of TEG in peripheral arterial disease (PAD) is unclear and its application as demonstrated in the literature has undergone limited appraisal. The objectives of our study were to identify whether TEG can inform individualised thromboprophylaxis and predict thrombotic events following re-vascularisation in PAD.

We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and a PRISMA checklist was completed. PubMed and Embase databases were searched from inception until October 2024 using the relevant Medical Subject Headings terms. Only full-text articles published in the English language reporting the outcomes in PAD with TEG or TEG with platelet mapping (TEG-PM) were analysed. The protocol was registered on the PROSPERO database (ID:CRD42024580627).

The analysis included 14 studies. TEG-PM was able to quantify the response to antiplatelet therapy and potentially guide individualised thromboprophylaxis. The parameters maximum amplitude, platelet aggregation and platelet inhibition were able to predict thrombotic events. However, substantial heterogeneity in thromboprophylaxis, surgical procedures and comorbidities was observed in the studies.

TEG-PM could serve as a valuable tool for tailoring antiplatelet therapy and predicting outcomes in patients with PAD. Further studies including randomised controlled trials are needed to validate the findings.