Thromb Haemost 2018; 118(10): 1832-1838
DOI: 10.1055/s-0038-1670658
Atherosclerosis and Ischaemic Disease
Georg Thieme Verlag KG Stuttgart · New York

Platelet Reactivity and Early Outcomes after Transfemoral Aortic Valve Implantation

Lisa Gross
1  Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
,
David Jochheim
1  Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
2  DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
,
Tobias Nitschke
1  Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
,
Moritz Baquet
1  Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
,
Martin Orban
1  Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
,
Lesca Holdt
3  Department of Laboratory Medicine, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
,
Magda Zadrozny
1  Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
,
Christian Hagl
2  DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
4  Department of Cardiac Surgery, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
,
Daniel Teupser
3  Department of Laboratory Medicine, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
,
Axel Bauer
1  Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
2  DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
,
Steffen Massberg
1  Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
2  DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
,
Julinda Mehilli*
1  Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
2  DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
,
Dirk Sibbing*
1  Department of Cardiology, Munich University Hospital, Ludwig-Maximilians-Universität München (LMU Munich), Munich, Germany
2  DZHK (German Center for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
› Author Affiliations
Further Information

Publication History

17 June 2018

08 August 2018

Publication Date:
20 September 2018 (eFirst)

Abstract

Beyond thromboembolic events, peri-procedural bleeding remains one of the most frequent complications after transcatheter aortic valve implantation (TAVI). The majority of TAVI patients receive a dual anti-platelet treatment (DAPT) regimen. This analysis from the EVERY-TAVI register database aimed to analyse whether the level of on-treatment adenosine diphosphate-induced platelet reactivity predicts early outcomes at 30 days after TAVI. A total of 146 consecutive TAVI patients on DAPT who underwent platelet function testing with the Multiplate analyser were included here. Definition of bleeding events was done according to the Valve Academic Research Consortium-2 (VARC-2) classification. In our cohort, a status of low platelet reactivity (LPR, ≤ 18 units) was observed in 79 patients (54%), while high platelet reactivity (HPR, ≥ 46 units) was present in 18 patients (12%). At 30-day follow-up, the incidence of VARC-2 bleeds was 45.6% (n = 36) in LPR patients and 23.9% (n = 16) in patients without LPR (hazard ratio [HR] 2.10, 95% confidence interval [CI], 1.17–3.79; p = 0.01). In age-adjusted multivariate analysis, a status of LPR was independently associated with VARC-2 bleeding events (HRadj, 2.06, 95% CI, 1.14–3.71; p = 0.02). HPR was not associated with the 30-day risk of death, stroke, or myocardial infarction (p ≥ 0.43). In summary, presence of LPR was associated with bleeding events in patients undergoing TAVI while presence of HPR was not associated with ischaemic outcomes at 30 days. The value of platelet function testing for bleeding risk prediction and for a possible guidance of anti-thrombotic treatment in the elderly TAVI population warrants further investigation.

* Julinda Mehilli and Dirk Sibbing are shared senior co-authors of the article.