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.