Platelet Activation Is Limited during Transcatheter Aortic Valve Implantation in Patients on Aspirin Monotherapy and without per Procedural Clinical Complications

Nicolas Dumonteil; Marie Levade; Cédric Garcia; Thibault Lhermusier; Jennifer Series; Pauline Le Faouder; Bertrand Marcheix; Bernard Payrastre; Didier Carrié; Pierre Sié

doi:10.1055/s-0039-1692142

TH Open, Inhaltsverzeichnis

CC BY 4.0 · TH Open 2019; 03(02): e146-e152
DOI: 10.1055/s-0039-1692142

Original Article

Georg Thieme Verlag KG Stuttgart · New York

Platelet Activation Is Limited during Transcatheter Aortic Valve Implantation in Patients on Aspirin Monotherapy and without per Procedural Clinical Complications

Nicolas Dumonteil^*

¹Pôle Cardiovasculaire et Métabolique, Hôpital Rangueil, Toulouse, France

,

Marie Levade^*

²INSERM, U1048 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France

³Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France

,

Cédric Garcia

³Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France

,

Thibault Lhermusier

¹Pôle Cardiovasculaire et Métabolique, Hôpital Rangueil, Toulouse, France

²INSERM, U1048 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France

,

Jennifer Series

³Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France

,

Pauline Le Faouder

⁴MetaToul-Lipidomique, INSERM U1048 and Université Paul Sabatier Toulouse 3, Toulouse, France

,

Bertrand Marcheix

¹Pôle Cardiovasculaire et Métabolique, Hôpital Rangueil, Toulouse, France

,

Bernard Payrastre

²INSERM, U1048 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France

³Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France

,

Didier Carrié

¹Pôle Cardiovasculaire et Métabolique, Hôpital Rangueil, Toulouse, France

²INSERM, U1048 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France

,

Pierre Sié

²INSERM, U1048 and Université Toulouse 3, Institut des Maladies Métaboliques et Cardiovasculaires, Toulouse, France

³Laboratoire d'Hématologie, Centre Hospitalier Universitaire de Toulouse, Toulouse, France

› Institutsangaben

Abstract

Transcatheter aortic valve implantation (TAVI) is an established treatment option for symptomatic patients with severe aortic valve stenosis (AS). During and early after the procedure, both ischemic events (predominantly stroke) and bleedings remain prevalent. The optimal antithrombotic regimen is still debated. Single- versus dual-antiplatelet therapy is associated with a lower rate of severe bleeding, without difference in thrombotic complications. Although platelets have been empirically targeted, little is known on their contribution to these events primarily related to embolization of thrombotic material and tissue-derived debris from the wounded aortic valve and large vessels. The objective of this study was to assess local platelet activation in blood sampled in the ascending aorta immediately before and within minutes postimplantation. A series of 18 patients with AS on monotherapy with aspirin successfully underwent TAVI with the self-expandable Medtronic CoreValve by transfemoral route. No clinical thrombotic complication occurred at 30-day follow-up. Compared with patients with stable coronary artery disease unscathed of AS and similarly treated by low-dose aspirin, AS patients displayed a chronic state of platelet activation before TAVI, assessed in venous blood using various biomarkers. However, per procedure, in aortic blood, no change occurred between the two time points in the plasma levels of serotonin or 12-lipoxgenase products, or membrane exposure of granule markers CD62-P and CD63. Our results suggest that local acute platelet activation is limited during TAVI on monotherapy with aspirin.

Keywords

platelet activation - aortic valve stenosis - transcatheter aortic valve implantation

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Referenzen

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