Abstract Body: Introduction:
Thrombotic risk in peripheral artery disease is traditionally attributed to platelet activation; however, impaired fibrinolysis represents an underrecognized contributor to clot persistence. Hyperglycemia has been associated with impaired fibrinolysis, characterized by elevated activity of plasminogen activator inhibitor-1 (PAI-1) and decreased clot breakdown mediated by tissue plasminogen activator (tPA). We aimed to determine whether viscoelastic testing demonstrates an association between elevated HbA1c levels and fibrinolysis shutdown.

Methods:
This single-center retrospective cohort study (2023–2025) evaluated patients with peripheral arterial disease undergoing planned lower extremity revascularization using preoperative viscoelastic testing. Fibrinolysis was assessed using LY30 (percentage of clot lysis 30 minutes after maximum clot strength), with severe shutdown defined as ≤0.3%. HbA1c was categorized according to American Diabetes Association criteria (normal <5.7%, prediabetes 5.7–6.4%, diabetes ≥6.5%). Associations were examined using multivariable logistic regression adjusting for age, sex, smoking status, and antiplatelet therapy.
Results:
Among 127 patients, the prevalence of severe fibrinolysis shutdown increased across HbA1c categories (40.7% in normal, 44.4% in prediabetes, and 67.3% in diabetes) (Table 1). In multivariable analysis, diabetes was independently associated with severe fibrinolysis shutdown (adjusted odds ratio [OR] 3.12, 95% confidence interval [CI] 1.14–8.95, p = 0.029)(Table 2), whereas prediabetes showed no significant association. Continuous analysis revealed a progressive increase in the probability of shutdown with rising HbA1c. Distributional assessment indicated that this relationship was driven by clustering of near-zero LY30 values among patients with diabetes (Figure 1), rather than a uniform reduction in fibrinolytic activity across the cohort, suggesting a threshold-dependent impairment in fibrinolysis.
Conclusion:
Hyperglycemia is independently associated with fibrinolysis shutdown on viscoelastic testing. This provides an insight into underlying prothrombotic abnormalities, particularly in patients with peripheral arterial disease and diabetes, highlighting high-risk individuals who may benefit from targeted therapies to reduce thrombotic complications.