Thrombin Generation as a Method to Identify the Risk of Bleeding in High Clinical-Risk Patients Using Dual...

Area of Science:

• Cardiology
• Hematology
• Pharmacology

Background:

• Patients undergoing percutaneous coronary intervention (PCI) with dual antiplatelet therapy (DAPT) face increased bleeding risks.
• Identifying patients with DAPT at higher risk of bleeding remains a clinical challenge.

Purpose of the Study:

• To determine if thrombin generation measurements can enhance bleeding risk assessment in high-risk patients on DAPT.
• Investigate the utility of thrombin generation assays for predicting bleeding events post-PCI.

Main Methods:

• Assessed coagulation factors and thrombin generation in platelet-poor plasma from 93 high-risk, frail patients on DAPT post-PCI.
• Monitored clinically relevant bleeding events over a 12-month follow-up period.
• Compared thrombin generation parameters at 1 and 6 months between patients who bled and those who did not.

Main Results:

• Patients experiencing bleeding showed significantly lower thrombin generation (endogenous thrombin potential, peak height, velocity index) at 1 and 6 months post-PCI.
• Thrombin generation levels were strongly correlated with Factor II, V, VIII activity, and fibrinogen levels.
• Reduced thrombin generation was observed in the bleeding group compared to non-bleeders.

Conclusions:

• Impaired thrombin generation in platelet-poor plasma is associated with increased bleeding risk in high-risk patients on DAPT.
• Reduced thrombin-generating potential may act as a "second hit" exacerbating bleeding risk alongside DAPT.
• Thrombin generation measurement shows promise for improving the identification of bleeding risk in DAPT patients.