Changes in platelet function and coagulation after transcatheter aortic valve implantation evaluated with...

Area of Science:

• Cardiology
• Hematology
• Vascular Surgery

Background:

• Hypercoagulability is a concern during transcatheter aortic valve implantation (TAVI).
• Optimal perioperative antithrombotic therapy for TAVI remains controversial.
• Investigating perioperative coagulation and platelet function is crucial for TAVI management.

Purpose of the Study:

• To investigate perioperative coagulation and platelet function following TAVI.
• To utilize thromboelastography (TEG) 6s platelet mapping to assess these changes.
• To provide insights into appropriate antithrombotic therapy after TAVI.

Main Methods:

• A prospective observational study involving 25 TAVI patients.
• TEG 6s platelet mapping performed at three time points: pre-heparinization, postoperative day (POD) 1, and POD 3.
• Analysis of maximum clot strength (MA_HKH), clot strength without platelet function (MA_ActF), coagulation factor initiation time (R_HKH), and platelet function (G_p), including ADP/AA receptor-mediated responses (MA_ADP/AA, G_ADP/AA).

Main Results:

• Coagulation capacity increased, indicated by shortened R_HKH on POD 1 and POD 3.
• Platelet function decreased for 3 days post-TAVI, with reduced G_p and MA_ActF increase on POD 3.
• ADP receptor-mediated platelet aggregation (G_ADP) decreased in clopidogrel-naive patients, while aspirin response (G_AA) showed no significant change.

Conclusions:

• TAVI induces a significant antithrombotic shift for 3 days, characterized by increased coagulation and decreased platelet function.
• The ADP receptor system appears to be involved in the observed decrease in platelet function.
• Findings may guide the selection of optimal perioperative antithrombotic strategies for TAVI patients.