Objective Coagulation Profiling Provides Novel Insight into Potential Risk Factors for Peripheral Artery Disease in Women

Abstract

The prevalence and burden of peripheral artery disease (PAD) is equal, if not higher, in women as compared with men, and it is known that clinical outcomes in women after revascularization procedures are worse. However, women are notably under-represented in existing PAD studies, contributing to a significant gap in clinical knowledge regarding the risk factors and nature history of female-specific disease. Traditional comorbidities associated with cardiovascular disease and PAD are more prevalent in men than women, suggesting that alternative etiologies may be contributing to atherosclerosis in female patients. Thromboelastography with platelet mapping (TEG-PM) measures the viscoelastic properties of a blood clot as a dynamic process and may provide an integral key to the next stage of patient-centered hypercoaguability assessment. This prospective observational study aimed to characterize the clinical and TEG-PM profiles of female and male patients prior to lower extremity revascularization procedures. All patients undergoing named vessel revascularization during December 2020 to December 2021 at a large tertiary institution were prospectively included. TEG-PM assays were performed on patients prior to surgery. These data, along with clinical metrics, were compared between men and women. Univariate analysis was performed using the Student t test for continuous variables and the Fisher exact test for binary variables. One hundred twenty-one patients were enrolled, of which 40 (39.6%) were female. Female patients had significantly lower rates of hypertension (62.5% vs 88.9%; P < .01) and diabetes (25.0% vs 54.3%; P < .01) as compared with men. There were no significant differences in age at time of enrollment, body mass index, smoking status, or hyperlipidemia between groups (Table I). TEG-PM data demonstrated significantly higher levels of platelet aggregation in female patients compared with male patients (62.8 ± 36.6 vs 43.6 ± 34.9; P = .03) and significantly lower levels of platelet inhibition in female patients (37.2 ± 36.6 vs 56.4 ± 34.9; P = .03) (Fig 1). There was no significant difference in the use of monoantiplatet therapy (62.5% vs 61.7%; P = 1.00), dual antiplatelet therapy (22.5% vs 38.2%; P = 1.00), or anticoagulation (30.0% vs 46.9%; P = .08) between groups (Table I). In this preoperative cohort, we found traditional PAD risk factors, such as hypertension and diabetes, to be significantly higher in men compared with women. Viscoelastic data, however, showed significantly greater platelet reactivity in women compared with men. This important insight demonstrates that the prevailing paradigm of risk stratification and disease modification may not fit the female population with PAD, and provides an important basis for further research into gender-specific coagulation profiles.TableClinical and thromboelastography with platelet mapping metrics between female and male patients with peripheral arterial diseaseFemaleMean (SD) or No.(%)MaleMean (SD) or No.(%)PTotal patients4081Clinical factors Age, y69.1 (±11.7)67.4 (±10.2).50 BMI, kg/m226.8 (±8.9)27.5 (±4.9).65 Ever smoker19 (46.3)36 (44.4).85 HTN25 (62.5)72 (88.9)<.01 HLD27 (67.5)44 (54.3).18 DM10 (25.0)44 (54.3)<.01TEG values R time6.5 (±2.6)6.5 (±3.0).94 K time2.0 (±1.5)1.8 (±1.2).50 α-angle66.9 (±10.0)69.3 (±12.2).33 MA57.6 (±8.1)60.8 (±8.5).46Platelet mapping values % Platelet aggregation62.8 (±36.6)43.6 (±34.9).03 % Platelet inhibition37.2 (±36.6)56.4 (±34.9).03Anthrombotic therapy MAPT25 (62.5)50 (61.7)1.00 DAPT9 (22.5)31 (38.2)1.00 Full-dose AC12 (30.0)38 (46.9).08AC, Anticoagulation; BMI, body mass index; DAPT, dual antiplatelet therapy; DM, diabetes mellitus; HLD, hyperlipidemia; HTN, hypertension; MAPT, mono antiplatelet therapy; SD, standard deviation; TEG, thromboelastography.Boldface P indicates statistical significance. Open table in a new tab