Enya WANG, Adriana A. Rodriguez ALVAREZ, Isabella Ferlini CIERI, Mounika Naidu BOYA, Shiv PATEL, Jamie L. ATTWOOD, Anahita DUA
Journal of Surgery and Medicine - 2026;10(9):0-0
Background/Aim: Peripheral arterial disease (PAD) often requires revascularization, but postprocedural thrombotic complications can lead to adverse limb and survival outcomes. Anemia is common among older patients with PAD and may alter coagulation, yet its association with peri-revascularization hemostatic profiles remains unclear. This study evaluated whether anemia was associated with differences in coagulation profiles before and after lower extremity revascularization. Methods: This prospective, single-center study included patients with PAD who underwent revascularization from December 2022 to December 2024. Blood samples obtained before and one month after revascularization were analyzed using thromboelastography with platelet mapping (TEG-PM). Patients were categorized as anemic or non-anemic using prespecified hemoglobin thresholds. Continuous variables were compared using the Mann-Whitney U test, and categorical variables were analyzed using Fisher's exact test. Results: Among 344 patients, 62.8% were anemic. Compared with non-anemic patients, anemic patients were older (70 vs. 67 years, P = 0.004), had higher prevalences of diabetes mellitus (60.3% vs. 46.0%, P = 0.013) and coronary artery disease (60.8% vs. 43.7%, P = 0.002), and had lower hemoglobin levels (10.7 (1.6) vs. 14.4 (1.3) g/dL, P < 0.001). At baseline, anemic patients had greater clot strength, including higher MA-CK (65.0 (6.7) vs. 61.3 (6.3) mm, P < 0.001) and MA-CFF (29.1 (10.7) vs. 21.4 (7.7) mm, P < 0.001), as well as higher CFF-FLEV values (515 (201) vs. 400 (145) mg/dL, P < 0.001). Differences in selected fibrin-related parameters persisted at one month. Longitudinally, non-anemic patients showed larger increases in MA-CFF (4.4 (8.4) vs. -0.2 (9.5) mm, P = 0.002) and MA-ActF (3.1 (7.4) vs. -1.6 (8.2) mm, P < 0.001). Iron-deficient anemic patients had the highest clot-strength and fibrinogen-related values at both time points. Conclusion: Anemic patients with PAD demonstrated higher clot strength and fibrin activity on TEG-PM before and after revascularization. These findings identify anemia as a marker of a more prothrombotic viscoelastic profile and warrant further study of its role in thrombotic risk stratification.
