RESUMO
OBJECTIVES: Graft/stent thrombosis is the leading cause of amputation in patients over 60, and while dual antiplatelet therapy is the standard of care, there is a significant variability in platelet response and limited guidance on measuring effectiveness. Thromboelastography with platelet mapping (TEG-PM) can objectively detail an individual's coagulation profile, namely the strength of the clot and its response to antiplatelet medication. Although TEG-PM has been used for predicting postoperative bleeding and assessing platelet dysfunction in TBI, its application in thrombosis diseases such as peripheral artery disease (PAD) remains unexplored. The aim of this observational study was to determine if objective measures of clot strength could predict a high clinical risk of thrombosis. METHODS: Patients > 60 years with peripheral artery disease (PAD) undergoing revascularization were prospectively evaluated from 2021-2023. They were clinically followed for one year to detect any thrombotic events. TEG-PM was used to objectively evaluate coagulation profiles in patients at 1, 3, 6, and 9 months. These follow-up periods were chosen based on studies showing that 1-3 month intervals in the first year after lower extremity revascularization (LER) optimize therapy and risk control. The TEG-PM data preceding a thrombotic/stenotic event in patients with thrombosis was compared to the last known well TEG-PM event in those without a thrombotic/stenotic event. We stratified the groups based on the occurrence of thrombosis/stenotic events. Descriptive statistics were applied to characterize each group and a chi-square test was conducted to assess the variance between both groups. An unpaired t-test was ran to identify differences in platelet function. ROC analysis was performed to determine the optimal TEG-PM cutoff for predicting a higher risk of thrombosis. RESULTS: One hundred and fifty-eight patients were analyzed, from whom 28 (17.7%) experienced a thrombotic event. The thrombosis cohort exhibited significantly greater MAADP, MAFibrin, and MAThrombin [50.2 vs. 40.0, p<0.05], [18.19 vs. 14.64, p<0.05] and [63.8 vs. 58.5, p<0.05] respectively indicative of greater clot strength. By ROC analysis, the optimal predictor cutoff for MAADP, indicating a higher risk of thrombosis, was >42mm [p<0.05] with 82% sensitivity and 50% specificity. CONCLUSIONS: An increase in clot strength was found to be predictive of thrombosis/stenosis within 30 days. Using a MAADP cutoff greater than 42mm might serve as an alternative approach to tailor the use of antiplatelet medication, potentially reducing the risk of thrombosis.
RESUMO
OBJETIVO: Verificar a associação de variáveis sociodemográficas e clínicas entre os diferentes níveis de atividade física praticada por idosos vinculados ao setor suplementar de saúde brasileira. MÉTODOS: Estudo quantitativo e de corte transversal conduzido com 361 idosos pertencentes a uma seguradora de planos de saúde, do segmento medicina de grupo, localizado na cidade de São Paulo, SP, Brasil. Para mensuração dos diferentes níveis de atividade física, aplicou-se o instrumento International Physical Activity Questionnaire (IPAQ) traduzido, adaptado e validado para a população geriátrica brasileira. Ademais, empregaram-se ainda instrumentos de caracterização sociodemográfica e de mensuração da capacidade funcional para as atividades de vida diária, a função cognitiva, os sintomas depressivos, a autopercepção da saúde, o estado nutricional e o risco de queda. Após análise descritiva, realizou-se análise comparativa por meio dos testes de ANOVA e de χ2. O teste de Brown-Forsythe foi utilizado para situações em que não foi encontrada homogeneidade e o teste de Dunnett para comparações múltiplas. RESULTADOS: Verificou-se que 63,3% dos idosos praticavam baixos níveis de atividade física e apenas 5,6% praticavam atividade física vigorosa. Nessa amostra, variáveis como autopercepção de saúde positiva (p = 0,032), sono adequado sem auxílio de medicações (p = 0,020) e independência para atividades de vida diária (p < 0,001) estiveram positivamente associadas ao aumento dos níveis de atividade física, enquanto idade avançada (p < 0,001), declínio cognitivo (p < 0,001), sintomas depressivos (p < 0,001) e dificuldade de mobilidade (p < 0,001) se associaram negativamente a baixos níveis de atividade física. CONCLUSÃO: Variáveis demográficas e clínicas são fatores associados positiva e negativamente com os diferentes níveis de atividade física de idosos pertencentes ao setor suplementar de saúde.
OBJECTIVE: To verify the association of sociodemographic and clinicai variables to different levels of physical activity in older adults enrolled in a health insurance plan in Brazil. METHODS: A quantitative cross-sectional study was conducted on a sample of 361 older adults enrolled in a health insurance plan in the city of São Paulo, SP, Brazil. Levels of physical activity were measured using the International Physical Activity Questionnaire (IPAQ), which has been translated, adapted and validated for use in Brazilian geriatric populations. Sociodemographic characteristics, functional capacity for activities of daily living, cognitive function, depressive symptoms, risk of falls, self-perceived health and nutritional status were also evaluated. Results were analyzed using descriptive methods followed by ANOVA and Chi-Square tests. When homogeneity of variances was violated, the Brown-Forsythe test was used, followed by Dunnett's test for multiple comparisons. RESULTS: Low levels of physical activity were reported by 63.3% of participants, with only 5.6% practicing vigorous physical activity. In this sample, variables such as positive self-perceived health (p = 0.032), adequate sleep without medication (p = 0.020) and independence for activities of daily living (p < 0.001) were positively associated with higher levels of physical activity. Advanced age (p < 0.001), cognitive decline (p < 0.001), depressive symptoms (p < 0.001) and mobility impairments (p < 0.001) were associated with low levels of physical activity. CONCLUSION: Demographic and clinical variables displayed positive and negative associations with different levels of physical activity in older adults receiving health insurance plans.
