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Updated: Jun 17, 2025
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Clot lysis time and thrombin generation in patients undergoing transcatheter aortic valve implantation
Aleksander Siniarski1,2, Aleksandra Gąsecka3, Katarzyna Krysińska4
1Department of Coronary Artery Disease and Heart Failure, Faculty of Medicine, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
Insights
Transcatheter aortic valve implantation (TAVI) improved coagulation profiles in severe aortic stenosis (AS) patients by reducing clot lysis time (CLT) and peak thrombin generation. Baseline CLT and C-reactive protein (CRP) predicted successful TAVI outcomes.
Area of Science:
- Cardiology
- Hematology
- Biochemistry
Background:
- Severe aortic stenosis (AS) is a prevalent valvular heart disease linked to mortality and coagulation abnormalities, including fibrin deposition.
- Transcatheter aortic valve implantation (TAVI) is a key treatment for high-risk AS patients.
Purpose of the Study:
- To evaluate the effect of TAVI on thrombin generation and clot lysis time (CLT) in severe AS patients.
Main Methods:
- Assessed 135 symptomatic AS patients before and after TAVI.
- Measured clot lysis time (CLT), lag time, peak thrombin generation, time to peak thrombin generation (ttPeak), and endogenous thrombin potential (ETP).
- Utilized clinical assessment, echocardiography, and multivariable linear regression analysis.
Main Results:
- TAVI significantly reduced CLT by 9% and peak thrombin concentration by 13%.
- Observed significant increases in lag time (20%) and ttPeak (12%) post-TAVI.
- Baseline CLT and C-reactive protein (CRP) levels independently predicted successful TAVI, defined by reduced mean aortic gradient.
Conclusions:
- TAVI positively impacts coagulation, decreasing CLT and peak thrombin generation while increasing lag time and ttPeak.
- CLT and CRP are crucial predictors of TAVI procedural success.
Background:
Aortic valve stenosis (AS) is the most prevalent valvular heart disease and is associated with a significant increase in mortality. AS has been shown to be linked with numerous coagulation system abnormalities, including increased fibrin deposition on the stenotic aortic valves. Transcatheter aortic valve implantation (TAVI) is the primary treatment method for patients at high surgical risk.
Objectives:
The aim of the study was to assess the impact of treating severe AS with TAVI on thrombin generation and clot lysis time (CLT).
Methods:
We studied 135 symptomatic AS patients recommended for TAVI by the local Heart Team. All measurements were performed before and 5-7 days after TAVI. Alongside clinical assessment and echocardiographic analysis, we assessed clot lysis time (CLT) and thrombin generation parameters, including lag time, peak thrombin generation, time to peak thrombin generation (ttPeak), and endogenous thrombin potential (ETP).
Results:
70 patients were included in the final analysis. After TAVI, there was a significant 9% reduction in CLT despite a 12% increase in fibrinogen concentration. We observed significant increase in lag time and ttPeak (20% and 12%, respectively), and 13% decrease in peak thrombin concentration compared to pre-procedural levels. Multivariable linear regression analysis demonstrated that baseline CLT and C-reactive protein (CRP) levels were independent predictors of significant reduction in mean aortic gradient, defined as TAVI procedure success.
Conclusions:
CLT and peak thrombin concentration decreased, while Lag time and ttPeak increased significantly after TAVI. Multivariable linear regression analysis demonstrated CLT and CRP levels as independent predictors of achieving a reduction in mean aortic gradient, defining TAVI procedure success.
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