Poor outcome following revascularization predicted by thromboelastography

Abstract Background Infrainguinal revascularization procedures are associated with a high risk of graft failure, amputation and early death. Hypercoagulability predicts a poor overall outcome but conventional tests are expensive and results are not immediately available. A cheap, rapid method for identifying hypercoagulability would allow screening before revascularization. Thromboelastography (TEG) is a rapid, reliable, bedside method of assessing whole blood clotting. Normally used to assess hypocoagulability, this study determined the role of TEG in identifying patients with a poor prognosis following revascularization. Methods Between November 1998 and January 2000, 106 patients with critical leg ischaemia were admitted for radiological or surgical revascularization (mean age 71 (range 33–90) years). All underwent TEG analysis, standard thrombophilia screening (STS), and fasting homocysteine and fibrinogen assays. All patients were followed for 6 months after revascularization by means of clinical examination, ankle: brachial pressure index (ABPI) and duplex imaging. Results At the 6-month follow-up of 106 patients, 29 (27 per cent) had arterial or graft occlusion, five (5 per cent) had died and four (4 per cent) had undergone a major amputation. Analysis of risk factors revealed that a hypercoagulable TEG (P = 0·0009), STS and/or raised fibrinogen level (P = 0·01), and rest pain (P = 0·006) were associated with poor outcome. Other factors such as age, sex, diabetes, current or previous smoking, coronary artery or cerebrovascular disease, hypertension, previous intervention, aspirin or lipid-lowering therapy were not significantly different. In addition, hyperlipidaemia, hyperhomocysteinaemia, raised level of C-reactive protein, eyrthrocyte sedimentation rate, lipoprotein a level, haemocrit, STS or fibrinogen alone were not useful as predictors of poor outcome. Conclusion TEG, a rapid inexpensive test of hypercoagulability, is associated with poor outcome following infrainguinal revascularization.