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Published on: August 8, 2025
Platelet reactivity in patients undergoing transcatheter aortic valve implantation
Katia Orvin1,2, Alon Eisen3,4, Leor Perl3,4
1Cardiology Department, Rabin Medical Center, 39 Jabotinsky St., 49100, Petah Tikva, Israel. katiaorvin@gmail.com.
Insights
Patients undergoing transcatheter aortic-valve implantation (TAVI) often show high on-treatment platelet reactivity (HTPR) despite dual antiplatelet treatment (DAPT). This residual reactivity persists post-procedure, potentially increasing thromboembolic event risk.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Transcatheter aortic-valve implantation (TAVI) is associated with a 3-5% risk of thromboembolic events, primarily stroke.
- Dual antiplatelet therapy (DAPT), typically aspirin and clopidogrel, is standard post-TAVI to mitigate these risks.
- High on-treatment platelet reactivity (HTPR), a diminished response to antiplatelet drugs, is a known risk factor for adverse events but its prevalence post-TAVI is understudied.
Purpose of the Study:
- To assess the prevalence and variability of platelet reactivity in patients undergoing TAVI.
- To evaluate residual platelet reactivity to aspirin and clopidogrel in the peri-procedural period and up to one month after TAVI.
Main Methods:
- A cohort of 40 patients (mean age 81.7 years, 66.7% women) who underwent successful TAVI were studied.
- Platelet reactivity was measured using VerifyNow P2Y12 assay for clopidogrel and multiple electrode aggregometry (Multiplate analyzer) for aspirin.
- Measurements were taken at baseline and at one month post-TAVI, with patients on various antiplatelet regimens.
Main Results:
- At baseline, 41% of patients exhibited HTPR to clopidogrel and 12.5% to aspirin.
- These rates of HTPR did not significantly change one month after the TAVI procedure (p=0.81 for clopidogrel, p=0.33 for aspirin).
- Patients were on DAPT or clopidogrel plus warfarin post-procedure.
Conclusions:
- Patients undergoing TAVI exhibit high rates of residual platelet reactivity, indicating suboptimal response to DAPT.
- This elevated reactivity persists from the peri-procedural period up to at least one month post-TAVI.
- These findings suggest a need to reconsider antiplatelet management strategies for TAVI patients to potentially improve outcomes.
Abstract:
Thromboembolic events, primarily stroke, might complicate transcatheter aortic-valve implantation (TAVI) procedures in 3-5 % of cases. Thus, it is common to administer aspirin and clopidogrel pharmacotherapy for 3-6 months following TAVI in order to prevent those events. The biologic response to the dual anti platelet treatment (DAPT) is heterogeneous, e.g. low response, known as high on treatment platelet reactivity (HTPR) may be associated with adverse thromboembolic events. Little is known about the prevalence of HTPR among patients undergoing TAVI. To assess the variability in response and rates of residual platelet reactivity in patients undergoing TAVI. We examined platelet reactivity in response to clopidogrel and aspirin in 40 consecutive patients (mean age 81.7 ± 6.5 years, 66.7 % women) who underwent successful TAVI using the VerifyNow P2Y12 assay and the multiple electrode aggregometry assay (Multiplate analyzer) in response to adenosine diphosphate and arachidonic acid respectively, at different time points before and following TAVI. Before TAVI, the majority of patients were on antiplatelet therapy (68.5 % aspirin, 12.5 % clopidogrel, 12.5 % DAPT). Following the procedure all patients were on DAPT or clopidogrel and warfarin. Among analyzed patients, 41 % had HTPR for clopidogrel and 12.5 % for aspirin at baseline, which did not significantly change 1-month following the procedure (p = 0.81 and p = 0.33, respectively). In conclusion, patients undergoing TAVI for severe aortic stenosis and treated with DAPT have high rates of residual platelet reactivity during the peri-procedural period and up to 1-month thereafter. These findings may have clinical implications for the anti-platelet management of TAVI patients.
