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

Introduction 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. Methods 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). Findings 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. Conclusions 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.