Hemostatic biomarkers and antithrombotic strategy in percutaneous left atrial interventions: State-of-the-art review

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomarker Research

Background:

• Percutaneous closure of atrial septal defects, patent foramen ovale, and left atrial appendage is common.
• Thromboembolic events are significant complications following these procedures.
• Optimal post-procedural antithrombotic management remains under investigation.

Purpose of the Study:

• To investigate the mechanisms of left atrial device-related thrombus and thromboembolic complications.
• To evaluate the temporal changes in coagulation and platelet activation post-procedure.
• To identify potential biomarkers for predicting device-related complications.

Main Methods:

• Monitoring of coagulation activation biomarkers after percutaneous device placement.
• Assessment of platelet reactivity following interventions.
• Analysis of endothelial activation and fibrinolysis markers.

Main Results:

• Biomarkers of coagulation activation were elevated post-procedure, peaking at one month and normalizing by three months.
• Platelet reactivity did not show a significant post-procedural increase.
• Elevated coagulation activation suggests a potential role for anticoagulation therapy.

Conclusions:

• Current antiplatelet-based regimens may not be optimal for preventing device-related thrombus.
• Anticoagulation therapy might be a more suitable strategy.
• Biomarkers of endothelial activation, fibrinolysis, and platelet reactivity could guide personalized antithrombotic strategies.