Impact of Transcatheter Aortic Valve Implantation on Thrombin Generation and Platelet Function.
Aged
Aged, 80 and over
Antithrombin III
Aortic Valve Stenosis
/ blood
Blood Platelets
/ metabolism
Female
Humans
Male
Peptide Fragments
/ blood
Peptide Hydrolases
/ blood
Pilot Projects
Platelet Activation
Platelet Aggregation
Platelet Function Tests
Prothrombin
Severity of Illness Index
Thrombin
/ metabolism
Time Factors
Transcatheter Aortic Valve Replacement
/ adverse effects
Treatment Outcome
Journal
Thrombosis and haemostasis
ISSN: 2567-689X
Titre abrégé: Thromb Haemost
Pays: Germany
ID NLM: 7608063
Informations de publication
Date de publication:
Oct 2021
Oct 2021
Historique:
pubmed:
25
3
2021
medline:
11
2
2022
entrez:
24
3
2021
Statut:
ppublish
Résumé
Transcatheter aortic valve implantation (TAVI) is an evolving treatment of severe aortic valve stenosis. However, thromboembolic events such as stroke are common, predominantly early after TAVI. Optimal periprocedural antithrombotic regime is unknown. Especially, as antithrombotic medication enhances bleeding risk, thrombin generation and platelet function are crucial in the pathogenesis of ischemic events. However, the impact of the TAVI procedure on thrombin formation and platelet reactivity is not known by now. We evaluated thrombin levels using thrombin-antithrombin (TAT) complexes and prothrombin fragments (PTFs) using enzyme-linked immunosorbent assay. Furthermore, platelet reactivity was measured via light transmission aggregometry before and 2 hours after TAVI in 198 patients. TAT complexes and PTF F1 + 2 substantially increased during TAVI. Postprocedurally, TAT complexes and PTF were significantly higher after TAVI compared with percutaneous coronary intervention due to acute myocardial infarction, while preprocedural TAT complexes and PTF F1 + 2 did not differ. In contrast, platelet reactivity was not altered early after TAVI. Only adenosine diphosphate-induced aggregation was reduced, reflecting preprocedural loading with clopidogrel. In this pilot study, we were able to demonstrate that thrombin generation is significantly increased early after TAVI, while platelet function is not affected. Increased thrombin concentrations may contribute to the high risk of postprocedural thromboembolic events. This leads to the hypothesis that extended peri-interventional anticoagulation early after TAVI may be an approach to reduce thromboembolic events.
Sections du résumé
BACKGROUND
BACKGROUND
Transcatheter aortic valve implantation (TAVI) is an evolving treatment of severe aortic valve stenosis. However, thromboembolic events such as stroke are common, predominantly early after TAVI. Optimal periprocedural antithrombotic regime is unknown. Especially, as antithrombotic medication enhances bleeding risk, thrombin generation and platelet function are crucial in the pathogenesis of ischemic events. However, the impact of the TAVI procedure on thrombin formation and platelet reactivity is not known by now.
METHODS
METHODS
We evaluated thrombin levels using thrombin-antithrombin (TAT) complexes and prothrombin fragments (PTFs) using enzyme-linked immunosorbent assay. Furthermore, platelet reactivity was measured via light transmission aggregometry before and 2 hours after TAVI in 198 patients.
RESULTS
RESULTS
TAT complexes and PTF F1 + 2 substantially increased during TAVI. Postprocedurally, TAT complexes and PTF were significantly higher after TAVI compared with percutaneous coronary intervention due to acute myocardial infarction, while preprocedural TAT complexes and PTF F1 + 2 did not differ. In contrast, platelet reactivity was not altered early after TAVI. Only adenosine diphosphate-induced aggregation was reduced, reflecting preprocedural loading with clopidogrel.
CONCLUSION
CONCLUSIONS
In this pilot study, we were able to demonstrate that thrombin generation is significantly increased early after TAVI, while platelet function is not affected. Increased thrombin concentrations may contribute to the high risk of postprocedural thromboembolic events. This leads to the hypothesis that extended peri-interventional anticoagulation early after TAVI may be an approach to reduce thromboembolic events.
Identifiants
pubmed: 33759144
doi: 10.1055/s-0041-1725190
doi:
Substances chimiques
Peptide Fragments
0
antithrombin III-protease complex
0
prothrombin fragment 1.2
0
Antithrombin III
9000-94-6
Prothrombin
9001-26-7
Peptide Hydrolases
EC 3.4.-
Thrombin
EC 3.4.21.5
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1310-1316Subventions
Organisme : 29-2019
ID : Forschungskommission of the Medical Faculty of the Heinrich Heine University
Organisme : 18-2019
ID : Forschungskommission of the Medical Faculty of the Heinrich Heine University
Organisme : PO 2247/1-1
ID : German Research Foundation
Organisme : SFB1116
ID : German Research Foundation
Informations de copyright
Thieme. All rights reserved.
Déclaration de conflit d'intérêts
None declared.