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Impact of Transcatheter Aortic Valve Implantation on Thrombin Generation and Platelet FunctionFunding This work was supported by the Forschungskommission of the Medical Faculty of the Heinrich Heine University (No. 29-2019, to L.D.; No. 18-2019, to A.P.) and by the German Research Foundation (PO 2247/1-1 to A.P. and SFB1116 to A.P.).
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 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 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 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.
The study conformed to the Declaration of Helsinki and was approved by the University of Düsseldorf Ethics Committee.
P.M., L.D., and A.P. designed the study, analyzed, and interpreted the data and wrote the manuscript. C.H., R.M., H.R., and S.Z. collected the data and revised the manuscript. A.P., C.J., T.Z., T.H., M.K., and V.V. supervised the study and revised the manuscript.
* These authors contributed equally to this work.
Received: 04 October 2020
Accepted: 09 January 2021
23 March 2021 (online)
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